Provider Demographics
NPI:1760050231
Name:PREMIER PHARMACY LLC
Entity Type:Organization
Organization Name:PREMIER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-559-2187
Mailing Address - Street 1:6530 S BUFFALO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2164
Mailing Address - Country:US
Mailing Address - Phone:702-444-2021
Mailing Address - Fax:702-444-2053
Practice Address - Street 1:6530 S BUFFALO DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2164
Practice Address - Country:US
Practice Address - Phone:702-444-2021
Practice Address - Fax:702-444-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPH04348OtherNEVADA PHARMACY LICENSE