Premier Pharmaceutical Services, LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

05058 11.1 Issued in MS

Legal business name

PREMIER PHARMACEUTICAL SERVICES, LLC

Practice address

1348 US Highway 61 S
Woodville, MS 39669-4560

Phone

(601) 888-7176

Fax

(601) 888-7134

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Gary Russell Johnson, PT

Title

Owner

Phone

(601) 888-7176

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356401491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1051",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396691051",
            "telephone_number": "601-888-7176",
            "fax_number": "601-888-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 US HIGHWAY 61 S",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396694560",
            "telephone_number": "601-888-7176",
            "fax_number": "601-888-7134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHARMACEUTICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-888-7176",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "MS",
            "license": "05058 11.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1434850",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00440778",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330599",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1268453",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David B McGraw, MD
• McKenzie Healthcare Solutions
• Mississippi State Department of Health
• Tobie Delton Moore, DDS
• Louis J Owens, M.D.
• Premier Physical Therapy, LLC
• Alicia Freeman Randall, LCSW
• Shelley Walters Redhead, PHARMACIST
• Pradeep Kumar Selvaraj, M.D
• Megan Sistrunk

• Oxygen Equipment & Supplies (DME) in Woodville, MS
• Providers in Woodville, MS by specialty
• Oxygen Equipment & Supplies (DME) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.