Provider Demographics
NPI:1790157618
Name:PREMIER PHARMACY LLC
Entity Type:Organization
Organization Name:PREMIER PHARMACY LLC
Other - Org Name:PREMIER PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KESIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-270-6501
Mailing Address - Street 1:150 MONUMENT RD
Mailing Address - Street 2:SUITE 601A
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1702
Mailing Address - Country:US
Mailing Address - Phone:484-270-6501
Mailing Address - Fax:
Practice Address - Street 1:150 MONUMENT RD STE 601A
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1701
Practice Address - Country:US
Practice Address - Phone:484-270-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482598333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155178OtherPK