MEDICARE: CENTERWELL PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH26551	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2012239	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235154725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	10749 MARKS WAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3976
Country	:	US
Telephone Number	:	800-526-1489
Fax Number	:	800-526-1491

Provider Business Practice Location Address
First Line	:	1651 S CONGRESS AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5903
Country	:	US
Telephone Number	:	561-966-1052
Fax Number	:	561-966-1057

Authorized Official
Title or Position	:	VP
Name	:	SEAN LYSINGER
Credential	:
Telephone Number	:	502-580-2376

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/12/2025

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