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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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPH29519FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12155150OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528431558
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL PHARMACY, INC.
Provider Business Mailing Address
First Line : 420 S NOVA RD STE 4/5
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-0410
Country : US
Telephone Number : 786-514-3927
Fax Number : 386-615-8438
Provider Business Practice Location Address
First Line : 420 S NOVA RD STE 4/5
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-0410
Country : US
Telephone Number : 386-281-6633
Fax Number :
Authorized Official
Title or Position : VP
Name : SEAN LYSINGER
Credential :
Telephone Number : 502-580-2376
Provider Enumeration Date : 11/13/2015
Last Update Date : 06/12/2025

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