Provider Demographics
NPI:1881143444
Name:PREMIER MEDICAL DISTRIBUTION
Entity type:Organization
Organization Name:PREMIER MEDICAL DISTRIBUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-285-0181
Mailing Address - Street 1:12393 S GATEWAY PARK PL
Mailing Address - Street 2:SUITE 75
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2309
Mailing Address - Country:US
Mailing Address - Phone:888-932-0019
Mailing Address - Fax:801-542-0611
Practice Address - Street 1:12393 S GATEWAY PARK PL
Practice Address - Street 2:SUITE 75
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2309
Practice Address - Country:US
Practice Address - Phone:888-932-0019
Practice Address - Fax:801-542-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81002311710333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy