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General NPI Number Information
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NPI Number | 1588663132
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Entity Type | Organization
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Legal Business Name | CENTRAL PHARMACY - LIVONIA LLC
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Dates
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Enumeration Date | 07/16/2005
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 31320 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3644
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Country | US
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Telephone | 734-427-3430
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Fax | 734-427-1293
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Provider Business Mailing Address
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Address Line | 31320 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3644
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Country | US
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Telephone | 734-427-3430
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Fax | 734-427-1293
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | PRAVEEN VENISETTY
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Credential |
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Telephone | 734-427-3430
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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 | 5301011005
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License Number State | MI
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