Healthcare Provider Details

I. General information

NPI: 1780609271
Provider Name (Legal Business Name): CENTERWELL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 JOHN F KENNEDY CAUSEWAY SUITE 120A
NORTH BAY VILLAGE FL
33141
US

IV. Provider business mailing address

10749 MARKS WAY
MIRAMAR FL
33025-3976
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-1512
  • Fax: 305-535-8193
Mailing address:
  • Phone: 800-526-1489
  • Fax: 800-526-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26443
License Number StateFL

VIII. Authorized Official

Name: SEAN LYSINGER
Title or Position: VP
Credential:
Phone: 502-580-2376