MEDICARE: CENTRAL PHARMACY GROUP 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
1	3336C0003X	Community/Retail Pharmacy	49894	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2116067	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871644856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PHARMACY GROUP INC

Provider Business Mailing Address
First Line	:	801 S CHEVY CHASE DR STE 111
Second Line	:	STE 111
City	:	GLENDALE
State	:	CA
Zip	:	91205-4435
Country	:	US
Telephone Number	:	818-502-9097
Fax Number	:	818-502-9750

Provider Business Practice Location Address
First Line	:	801 S CHEVY CHASE DR STE 111
Second Line	:	STE 111
City	:	GLENDALE
State	:	CA
Zip	:	91205-4435
Country	:	US
Telephone Number	:	818-502-9097
Fax Number	:	818-502-9750

Authorized Official
Title or Position	:	PIC
Name	:	RAFFI PAPAZIAN
Credential	:	PHARM D
Telephone Number	:	626-429-4415

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	11/04/2021

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