MEDICARE: CENTRAL PHARMACY - MAPLE VALLEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301008261	MI

General Provider Information

NPI Number	:	1275648818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PHARMACY - MAPLE VALLEY LLC

Provider Business Mailing Address
First Line	:	219 N MAIN ST
Second Line	:	P. O. BOX 930
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9577
Country	:	US
Telephone Number	:	517-615-4700
Fax Number	:	517-615-1354

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. EDDIE SAID
Credential	:
Telephone Number	:	517-615-4700

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/06/2023

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