Healthcare Provider Details

I. General information

NPI: 1497767990
Provider Name (Legal Business Name): CENTRAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 MAIN ST
CARRINGTON ND
58421-2024
US

IV. Provider business mailing address

990 MAIN ST
CARRINGTON ND
58421-2024
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2651
  • Fax: 701-652-1882
Mailing address:
  • Phone: 701-652-2651
  • Fax: 701-652-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR786
License Number StateND

VIII. Authorized Official

Name: MR. SHANE R WENDEL
Title or Position: OWNER
Credential: PHARM.D.
Phone: 701-652-2651