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General NPI Number Information
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NPI Number | 1952814485
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Entity Type | Organization
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Legal Business Name | CENTERWELL PHARMACY, INC.
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 692 N HOMESTEAD BLVD STE 104-105
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City | HOMESTEAD
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State | FL
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Zip | 33030-6236
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Country | US
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Telephone | 786-404-6810
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Fax | 305-246-5790
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Provider Business Mailing Address
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Address Line | 442 WASHINGTON AVENUE
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City | HOMESTEAD
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State | FL
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Zip | 33030
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Country | US
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Telephone | 786-404-6810
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Fax | 305-246-5790
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Authorized Official
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Title or Position | VP
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Name | SEAN LYSINGER
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Credential |
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Telephone | 502-580-2376
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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 | PH31032
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License Number State | FL
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