Healthcare Provider Details

I. General information

NPI: 1669546149
Provider Name (Legal Business Name): CENTRAL AVENUE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CENTRAL AVE N
VALLEY CITY ND
58072-2951
US

IV. Provider business mailing address

234 CENTRAL AVE N
VALLEY CITY ND
58072-2951
US

V. Phone/Fax

Practice location:
  • Phone: 701-845-5280
  • Fax: 701-845-1847
Mailing address:
  • Phone: 701-845-5280
  • Fax: 701-845-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number164
License Number StateND

VIII. Authorized Official

Name: MATTHEW PERKINS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 701-252-3002