Provider Demographics
NPI:1518230721
Name:24 HOUR PHARMACY RX STORE
Entity Type:Organization
Organization Name:24 HOUR PHARMACY RX STORE
Other - Org Name:PREMIER PHARMACY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:586-619-3950
Mailing Address - Street 1:30801 SCHOENHERR RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6857
Mailing Address - Country:US
Mailing Address - Phone:586-619-3950
Mailing Address - Fax:586-619-3951
Practice Address - Street 1:30801 SCHOENHERR RD STE 500
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6857
Practice Address - Country:US
Practice Address - Phone:586-619-3950
Practice Address - Fax:586-619-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336M0003X
MI53010098033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376449OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI6718080001Medicare NSC