Provider Demographics
NPI:1578728895
Name:PREMIUM PHARMACY INC
Entity Type:Organization
Organization Name:PREMIUM PHARMACY INC
Other - Org Name:PREMIUM PHARMACY DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-385-2900
Mailing Address - Street 1:8901 SW 157TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1102
Mailing Address - Country:US
Mailing Address - Phone:305-385-2900
Mailing Address - Fax:305-385-2999
Practice Address - Street 1:8901 SW 157TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1102
Practice Address - Country:US
Practice Address - Phone:305-385-2900
Practice Address - Fax:305-385-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH235053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036854OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1036854OtherNCPDP PROVIDER IDENTIFICATION NUMBER