| Organization Name: | PREMIERE HEALTHCARE LLC |
| NPI Number: | 1215258652 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILLIP KEITH WILKINS (PHARMACY OWNER) |
| Mailing Address: | 513 N Grand Ave Doniphan |
| State: | MO US |
| Postal Code: | 639351405 |
| Phone Number: | 5739963784 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2010 |
| NPI Last Update Date: | 11/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |