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General NPI Number Information
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NPI Number | 1417946062
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Entity Type | Organization
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Legal Business Name | CENTRAL MEDICAL ARTS PHARMACY
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 2475 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3221
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Country | US
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Telephone | 216-621-9073
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Fax | 216-621-9685
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Provider Business Mailing Address
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Address Line | 2475 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3221
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Country | US
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Telephone | 216-621-9073
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Fax | 216-621-9685
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Authorized Official
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Title or Position | OWNER
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Name | MR. BERTON COLLEN
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Credential | R.PH
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Telephone | 216-621-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 02163550
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License Number State | OH
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