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NPI Code Detail

MEDICARE: CENTRAL CARE PHARMACY LLC

MEDICARE: CENTRAL CARE PHARMACY LLC
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
13336C0003XCommunity/Retail Pharmacy264841MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427471895
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL CARE PHARMACY LLC
Provider Business Mailing Address
First Line : 12526 ZUMBROTA STREET NE
Second Line :
City : BLAINE
State : MN
Zip : 55449
Country : US
Telephone Number : 765-409-7801
Fax Number :
Provider Business Practice Location Address
First Line : 2336 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3710
Country : US
Telephone Number : 612-338-3005
Fax Number :
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : MRS. SAJEDA ABDO
Credential :
Telephone Number : 765-409-7801
Provider Enumeration Date : 01/21/2014
Last Update Date : 11/10/2015

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