Provider Demographics
NPI:1629514989
Name:PREMIER SPECIALTY INFUSION LLC
Entity Type:Organization
Organization Name:PREMIER SPECIALTY INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:877-629-4446
Mailing Address - Street 1:2401 HASSEL RD.
Mailing Address - Street 2:SUITE 1525
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7220
Mailing Address - Country:US
Mailing Address - Phone:800-783-9655
Mailing Address - Fax:877-770-4179
Practice Address - Street 1:2401 HASSELL RD STE 1525
Practice Address - Street 2:SUITE #1525
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2000
Practice Address - Country:US
Practice Address - Phone:877-629-4446
Practice Address - Fax:877-599-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy