Provider Demographics
NPI:1851442859
Name:PREMIUM PHARMACY
Entity Type:Organization
Organization Name:PREMIUM PHARMACY
Other - Org Name:FARMACIA LUIS #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-444-4908
Mailing Address - Street 1:10 AVE LAGUNA
Mailing Address - Street 2:LAGUNA GARDEN SHP CTR. #115
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6400
Mailing Address - Country:US
Mailing Address - Phone:787-791-2065
Mailing Address - Fax:787-253-1002
Practice Address - Street 1:10 AVE LAGUNA
Practice Address - Street 2:LAGUNA GARDEN SHP CTR. #115
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6400
Practice Address - Country:US
Practice Address - Phone:787-791-2171
Practice Address - Fax:787-253-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135139OtherPK