Healthcare Provider Details

I. General information

NPI: 1508314246
Provider Name (Legal Business Name): CENTERWELL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S RAINBOW BLVD
LAS VEGAS NV
89145-6231
US

IV. Provider business mailing address

1000 S RAINBOW BLVD
LAS VEGAS NV
89145-6231
US

V. Phone/Fax

Practice location:
  • Phone: 702-854-7812
  • Fax: 702-259-2404
Mailing address:
  • Phone: 702-854-7812
  • Fax: 702-259-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH03608
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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