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General NPI Number Information
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NPI Number | 1508953795
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Entity Type | Organization
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Legal Business Name | CENTERVILLE VILLAGE PHARMACY
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 666 E MAIN ST
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City | CENTREVILLE
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State | MI
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Zip | 49032-9803
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Country | US
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Telephone | 269-467-6354
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Fax | 269-467-8503
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | CENTREVILLE
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State | MI
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Zip | 49032-0547
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Country | US
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Telephone | 269-467-6354
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Fax | 269-467-8503
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Authorized Official
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Title or Position | PHARMACIST
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Name | CHARLES THOMPSON
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Credential | PHARMACIST
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Telephone | 269-467-6354
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007448
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License Number State | MI
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