Healthcare Provider Details

I. General information

NPI: 1336230879
Provider Name (Legal Business Name): CENTRAL PHARMACY-CHESANING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W. BROAD ST
CHESANING MI
48616
US

IV. Provider business mailing address

126 W. BROAD ST
CHESANING MI
48616
US

V. Phone/Fax

Practice location:
  • Phone: 989-845-3609
  • Fax: 989-845-3121
Mailing address:
  • Phone: 989-845-3609
  • Fax: 989-845-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5301000323
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010746
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberFC5608445
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID M LARNER
Title or Position: MEMBER
Credential:
Phone: 517-410-8581