Provider Demographics
NPI:1982236584
Name:PREMIER PHARMACY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PREMIER PHARMACY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTEZ
Authorized Official - Middle Name:LAVARD
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-496-9182
Mailing Address - Street 1:3010 MONROE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7533
Mailing Address - Country:US
Mailing Address - Phone:704-496-9182
Mailing Address - Fax:704-496-9903
Practice Address - Street 1:3010 MONROE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7533
Practice Address - Country:US
Practice Address - Phone:704-496-9182
Practice Address - Fax:704-496-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy