=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457465346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL DRUG LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 PEERLESS XING NW
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37312-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-339-3363
-----------------------------------------------------
Fax | 423-339-9692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1075 PEERLESS XING NW
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37312-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-339-3363
-----------------------------------------------------
Fax | 423-339-9692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICAH BOWEN CRAINE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 423-339-3363
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 4259
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------