Healthcare Provider Details

I. General information

NPI: 1881676450
Provider Name (Legal Business Name): CENTRAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MACDONALD AVE
RICHMOND CA
94804-1821
US

IV. Provider business mailing address

2300 MACDONALD AVE
RICHMOND CA
94804-1821
US

V. Phone/Fax

Practice location:
  • Phone: 510-234-4381
  • Fax: 510-234-7803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY33834
License Number StateCA

VIII. Authorized Official

Name: ROBERT SPECK
Title or Position: PIC
Credential:
Phone: 510-234-4383