Provider Demographics
NPI:1760799795
Name:PREMIER INFECTIOUS DISEASE ASSOC. P.A.
Entity Type:Organization
Organization Name:PREMIER INFECTIOUS DISEASE ASSOC. P.A.
Other - Org Name:PREMIER ID PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-587-8777
Mailing Address - Street 1:PO BOX 11230
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1230
Mailing Address - Country:US
Mailing Address - Phone:832-316-4720
Mailing Address - Fax:
Practice Address - Street 1:800 PEAKWOOD DR STE 3A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2913
Practice Address - Country:US
Practice Address - Phone:281-587-8777
Practice Address - Fax:281-587-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270553336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901005OtherNCPDP PROVIDER IDENTIFICATION NUMBER