MEDICARE: GRAND CENTRAL PHARMACY 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	026735	NY

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	:	1770617185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND CENTRAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	420 CENTRAL AVE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1907
Country	:	US
Telephone Number	:	516-295-8880
Fax Number	:	516-295-8879

Provider Business Practice Location Address
First Line	:	420 CENTRAL AVE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1907
Country	:	US
Telephone Number	:	516-295-8880
Fax Number	:	516-295-8879

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE FUCHS
Credential	:	PHARMACICST
Telephone Number	:	516-295-8880

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/11/2022

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