Premier One Pharma Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28607 Issued in TX

Legal business name

PREMIER ONE PHARMA INC.

Practice address

4927 Lake Ridge Pkwy Ste #180
Grand Prairie, TX 75052

Phone

(972) 522-7606

Fax

(972) 522-7607

NPI assigned

Apr 22, 2013

Organization subpart

No

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

Authorized official

Name

Dung Nguyen

Title

Pharmacy Manager

Phone

(972) 522-7606

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lake Ridge Pharmacy Doing business as

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

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478131200000",
    "number": "1407290356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE #180",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "75052",
            "telephone_number": "972-522-7606",
            "fax_number": "972-522-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE #180",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "75052",
            "telephone_number": "972-522-7606",
            "fax_number": "972-522-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ONE PHARMA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-22",
        "last_updated": "2016-11-03",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "DUNG",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "972-522-7606"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "28607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140442",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146826",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Ridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; 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.