1174841860 NPI number — PREMIER PHARMACY INTERNATIONAL, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174841860 NPI number — PREMIER PHARMACY INTERNATIONAL, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PHARMACY INTERNATIONAL, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOTZE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174841860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20214 BRAIDWOOD DR
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77450-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-828-9088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20214 BRAIDWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-828-9088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FOLSOM
Authorized Official First Name:
TAMBRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
281-698-8624

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18732 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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