Provider Demographics
NPI:1750459996
Name:PREMIER PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:PREMIER PHARMACEUTICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DUNG
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-832-9358
Mailing Address - Street 1:18080 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4437
Mailing Address - Country:US
Mailing Address - Phone:925-556-9680
Mailing Address - Fax:925-328-1900
Practice Address - Street 1:18080 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4437
Practice Address - Country:US
Practice Address - Phone:925-556-9680
Practice Address - Fax:925-328-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY538993336L0003X, 3336L0003X
3336I0012X
CAPHY440463336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA440460Medicaid
1993279OtherPK
3891790001Medicare NSC
CAPHA440460Medicaid