Premium Pharma, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31977 Issued in TX

Legal business name

PREMIUM PHARMA, LLC

Doing business as

The Pharmacy at Bergheim

Practice address

1 FM 3351 S Ste 115
Boerne, TX 78006

Phone

(830) 336-2882

Fax

(830) 336-2883

NPI assigned

May 8, 2018

Last updated

Nov 15, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dudley KlattNPI 1750856357

Title

VP of Operations

Phone

(361) 227-0412

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• The Pharmacy at Bergheim Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dudley Iles Klatt II, PHARM.D.

  • Pharmacist
  • San Antonio, TX
  • NPI 1750856357
  NPD Authorized official
• Rolando Ramon Jr., RPH

  • Pharmacist
  • Boerne, TX
  • NPI 1477138675
  NPD (past)

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1578052312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FM 3351 S STE 115",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780065729",
            "telephone_number": "830-336-2882",
            "fax_number": "830-336-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FM 3351 S STE 115",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78006",
            "telephone_number": "830-336-2882",
            "fax_number": "830-336-2883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4503 De Zavala Rd Ste 112",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782492060",
            "country_code": "US",
            "telephone_number": "210-332-5900",
            "fax_number": "210-332-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIUM PHARMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-08",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "KLATT",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "361-227-0412"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177272",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pharmacy at Bergheim",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Boerne, TX
• Providers in Boerne, 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 15, 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.