MEDICARE: CENTRAL DRUG 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
1	3336C0003X	Community/Retail Pharmacy	4259	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1457465346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL DRUG LLC

Provider Business Mailing Address
First Line	:	1075 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:	423-339-3363
Fax Number	:	423-339-9692

Provider Business Practice Location Address
First Line	:	1075 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:	423-339-3363
Fax Number	:	423-339-9692

Authorized Official
Title or Position	:	OWNER
Name	:	MICAH BOWEN CRAINE
Credential	:	PHARMD
Telephone Number	:	423-339-3363

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/06/2025

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