Provider Demographics
NPI:1912357476
Name:PREMIER PHARMACY NETWORK III LLC
Entity Type:Organization
Organization Name:PREMIER PHARMACY NETWORK III LLC
Other - Org Name:MAX-WELL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-485-7750
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-0428
Mailing Address - Country:US
Mailing Address - Phone:610-485-7750
Mailing Address - Fax:
Practice Address - Street 1:375 W STREET RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3218
Practice Address - Country:US
Practice Address - Phone:215-956-9280
Practice Address - Fax:215-956-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4813403336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164374OtherPK