1780609271 NPI number — CENTERWELL PHARMACY, INC.

Table of content: (NPI 1780609271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780609271 NPI number — CENTERWELL PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERWELL PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780609271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10749 MARKS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-3976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-526-1489
Provider Business Mailing Address Fax Number:
800-526-1491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 JOHN F KENNEDY CAUSEWAY
Provider Second Line Business Practice Location Address:
SUITE 120A
Provider Business Practice Location Address City Name:
NORTH BAY VILLAGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-535-1512
Provider Business Practice Location Address Fax Number:
305-535-8193
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH26443 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2013023 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011693500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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