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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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacyPH03608NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12164075OTHERPK

General Provider Information

NPI Number : 1508314246
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL PHARMACY, INC.
Provider Business Mailing Address
First Line : 1000 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-6231
Country : US
Telephone Number : 702-854-7812
Fax Number : 702-259-2404
Provider Business Practice Location Address
First Line : 1000 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-6231
Country : US
Telephone Number : 702-854-7812
Fax Number : 702-259-2404
Authorized Official
Title or Position : VP
Name : SEAN LYSINGER
Credential :
Telephone Number : 502-580-2376
Provider Enumeration Date : 09/12/2016
Last Update Date : 02/24/2026

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Directions to “CENTERWELL PHARMACY, INC. ” Practice Location

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