Active NPI
Premier Pharmacy Services Inc
- Community/Retail Pharmacy
- Millersburg, OH
National Provider Identifier
1073198131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- PREMIER PHARMACY SERVICES INC
- Practice address
- 2105 Glen Dr
Millersburg, OH 44654-8905 - Phone
- (234) 301-9166
- Fax
- (234) 301-9187
- NPI assigned
- Mar 10, 2021
- Last updated
- Oct 8, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Joel Gause
- Title
- President
- Phone
- (330) 893-0290
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | NU | Primary | |
| Long Term Care Pharmacy | 3336L0003X | NU |
Addresses
Primary practice location
2105 Glen Dr
Millersburg, OH 44654-8905
Mailing address
PO Box 78
Berlin, OH 44610-0078
Phone (330) 893-0290
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0436163 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210929002692 | OH | Part B Supplier - Pharmacy | 2466705579 | Practice locations: Millersburg, OH |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Premier Pharmacy Services
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Sugarcreek, OH
- NPI 1063103422
-
- Long Term Care Pharmacy
- Sugarcreek, OH
- NPI 1184474330
-
dba Wayne Holmes Health
- Durable Medical Equipment & Medical Supplies
- Wooster, OH
- NPI 1700737327
Locations
2105 Glen Dr
Millersburg, OH 44654
Phone (234) 301-9166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615334400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1633651200000",
"number": "1073198131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 78",
"city": "BERLIN",
"state": "OH",
"postal_code": "446100078",
"telephone_number": "330-893-0290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 GLEN DR",
"city": "MILLERSBURG",
"state": "OH",
"postal_code": "446548905",
"telephone_number": "234-301-9166",
"fax_number": "234-301-9187"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER PHARMACY SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2021-03-10",
"last_updated": "2021-10-08",
"certification_date": "2021-10-08",
"status": "A",
"authorized_official_last_name": "GAUSE",
"authorized_official_first_name": "JOEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "330-893-0290"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0436163",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Millersburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.