NPIMap

Organization Active NPI

Premier Compounding Pharmacy, Inc.

  • Long Term Care Pharmacy
  • Palm Beach Gardens, FL
National Provider Identifier
1205377173
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PH23481 Issued in FL
Legal business name
PREMIER COMPOUNDING PHARMACY, INC.
Practice address
2000 Pga Blvd.
Suite 5507
Palm Beach Gardens, FL 33408
Phone
(888) 507-8621
NPI assigned
Mar 13, 2017
Organization subpart
Yes
Parent organization
PREMIER COMPOUNDING PHARMACY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Tracy Christian, RPH, OWNERNPI 1740880624
Title
President/Ceo/Owner
Phone
(888) 507-8621

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X PH23481 FL Primary

Addresses

Primary practice location

2000 Pga Blvd.
Suite 5507
Palm Beach Gardens, FL 33408

Mailing address

2000 Pga Blvd.
Suite 5507
Palm Beach Gardens, FL 33408
Phone (888) 507-8621

Other identifiers 1

IdentifierTypeStateIssuer
2168181OtherPK

Other names 2

  • Premier Pharmacy LTC Doing business as
  • United LTC Rx Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Compounding Pharmacy Inc2 organizations share this tax ID, including this one
Part of
Premier Compounding Pharmacy Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1205377173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PGA BLVD.",
            "address_2": "SUITE 5507",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33408",
            "telephone_number": "888-507-8621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PGA BLVD.",
            "address_2": "SUITE 5507",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33408",
            "telephone_number": "888-507-8621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER COMPOUNDING PHARMACY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER COMPOUNDING PHARMACY, INC.",
        "enumeration_date": "2017-03-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "CHRISTIAN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "PRESIDENT/CEO/OWNER",
        "authorized_official_telephone_number": "888-507-8621",
        "authorized_official_credential": "RPH, OWNER"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "FL",
            "license": "PH23481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168181",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "United LTC Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Beach Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.