Premier Specialty Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010313 Issued in GA

Legal business name

PREMIER SPECIALTY PHARMACY LLC

Practice address

11720 Medlock Bridge Rd Ste 162
Johns Creek, GA 30097-1513

Phone

(770) 622-8901

Fax

(770) 622-8900

NPI assigned

Sep 16, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Buffy Gougelmann

Title

Pharmacist in Charge

Phone

(770) 622-8901

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Premier Specialty Pharmacy Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1013465236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 LUM CROWE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300756879",
            "telephone_number": "678-478-8019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 MEDLOCK BRIDGE RD STE 162",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971513",
            "telephone_number": "770-622-8901",
            "fax_number": "770-622-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SPECIALTY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-16",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "GOUGELMANN",
        "authorized_official_first_name": "BUFFY",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "770-622-8901"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010313",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166839",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Specialty Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Retail Pharmacy in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.