Provider Demographics
NPI:1285975573
Name:PREMIER HEALTH PHARMACY INC
Entity type:Organization
Organization Name:PREMIER HEALTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-877-2536
Mailing Address - Street 1:20-07 127TH STREET
Mailing Address - Street 2:#G33
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356
Mailing Address - Country:US
Mailing Address - Phone:718-661-0872
Mailing Address - Fax:
Practice Address - Street 1:20-07 127TH STREET
Practice Address - Street 2:#G33
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:718-661-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032019333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6848710001Medicare NSC