Provider Demographics
NPI:1609915487
Name:PREMIER HEALTH SERVICES
Entity Type:Organization
Organization Name:PREMIER HEALTH SERVICES
Other - Org Name:VICTORY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TWUMASI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPOFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-372-1313
Mailing Address - Street 1:1238 SPRINGFEILD AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1238 SPRINGFEILD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-372-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00632300333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3145821OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0026166Medicare ID - Type Unspecified