MEDICARE: CENTRAL PHARMACY--LAINGSBURG, 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301010264	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143855	OTHER		PK

General Provider Information

NPI Number	:	1679996490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PHARMACY--LAINGSBURG, LLC

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848-0310
Country	:	US
Telephone Number	:	517-651-1777
Fax Number	:	517-651-1779

Provider Business Practice Location Address
First Line	:	209 E GRAND RIVER RD
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848-9759
Country	:	US
Telephone Number	:	517-657-1777
Fax Number	:	517-651-1779

Authorized Official
Title or Position	:	PHARMACIST
Name	:	TIMOTHY PARKER
Credential	:
Telephone Number	:	517-651-1777

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	10/09/2020

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