Provider Demographics
NPI:1922487867
Name:PREMIER RX REPACKS, LLC
Entity Type:Organization
Organization Name:PREMIER RX REPACKS, LLC
Other - Org Name:UNITED LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-899-4429
Mailing Address - Street 1:2000 PGA BLVD STE 5508
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2726
Mailing Address - Country:US
Mailing Address - Phone:561-899-4429
Mailing Address - Fax:855-367-6979
Practice Address - Street 1:2000 PGA BLVD STE 5508
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-2726
Practice Address - Country:US
Practice Address - Phone:561-899-4429
Practice Address - Fax:855-367-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH289003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy