Healthcare Provider Details

I. General information

NPI: 1104381276
Provider Name (Legal Business Name): CENTRAL PHARMACY - CHARLOTTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 S COCHRAN AVE STE 3
CHARLOTTE MI
48813-1569
US

IV. Provider business mailing address

354 S COCHRAN AVE STE 3
CHARLOTTE MI
48813-1569
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-9990
  • Fax:
Mailing address:
  • Phone: 517-543-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE SAID
Title or Position: OFFICER
Credential:
Phone: 517-543-9990