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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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336M0002XMail Order Pharmacy4370AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11991956OTHERPK

General Provider Information

NPI Number : 1710927462
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL PHARMACY, INC.
Provider Business Mailing Address
First Line : 4302 W BUCKEYE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-4904
Country : US
Telephone Number : 800-379-0092
Fax Number :
Provider Business Practice Location Address
First Line : 4302 W BUCKEYE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-4904
Country : US
Telephone Number : 800-379-0092
Fax Number : 800-379-7617
Authorized Official
Title or Position : VP
Name : SEAN LYSINGER
Credential :
Telephone Number : 502-580-2376
Provider Enumeration Date : 06/08/2006
Last Update Date : 06/12/2025

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