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NPI Code Detail

MEDICARE: CENTERWELL PHARMACY, INC.

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
13336C0002XClinic Pharmacy
23336C0003XCommunity/Retail PharmacyPH21908FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12015119OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407930043
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 : 975 W 49TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3412
Country : US
Telephone Number : 305-512-9381
Fax Number : 305-826-3618
Authorized Official
Title or Position : VP
Name : SEAN LYSINGER
Credential :
Telephone Number : 502-580-2376
Provider Enumeration Date : 10/24/2006
Last Update Date : 02/24/2026

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