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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH31032	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2173104	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952814485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	442 WASHINGTON AVENUE
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030
Country	:	US
Telephone Number	:	786-404-6810
Fax Number	:	305-246-5790

Provider Business Practice Location Address
First Line	:	692 N HOMESTEAD BLVD STE 104-105
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-6236
Country	:	US
Telephone Number	:	786-404-6810
Fax Number	:	305-246-5790

Authorized Official
Title or Position	:	VP
Name	:	SEAN LYSINGER
Credential	:
Telephone Number	:	502-580-2376

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	06/12/2025

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Directions to “CENTERWELL PHARMACY, INC. ” Practice Location

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