Healthcare Provider Details

I. General information

NPI: 1508310772
Provider Name (Legal Business Name): CENTERWELL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12602 TOEPPERWEIN RD SUITE 100
LIVE OAK TX
78233-3269
US

IV. Provider business mailing address

12602 TOEPPERWEIN RD SUITE 100
LIVE OAK TX
78233-3269
US

V. Phone/Fax

Practice location:
  • Phone: 210-672-6510
  • Fax:
Mailing address:
  • Phone: 210-672-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number30954
License Number StateTX
# 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