Provider Demographics
NPI:1548767395
Name:PREMIER PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:PREMIER PHARMACY SERVICES INC
Other - Org Name:PREMIER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-204-6734
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610-0078
Mailing Address - Country:US
Mailing Address - Phone:330-204-6734
Mailing Address - Fax:
Practice Address - Street 1:4925 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44681
Practice Address - Country:US
Practice Address - Phone:330-893-0290
Practice Address - Fax:855-420-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336M0002X
OH0228862003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177393OtherPK