Provider Demographics
NPI:1194198374
Name:CENTRAL PHARMACY INC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY INC
Other - Org Name:ST JOSEPH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,CFO, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED ESLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMISSIREY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-444-6612
Mailing Address - Street 1:333 W THOMAS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4401
Mailing Address - Country:US
Mailing Address - Phone:480-444-6612
Mailing Address - Fax:480-371-2757
Practice Address - Street 1:333 W THOMAS RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4401
Practice Address - Country:US
Practice Address - Phone:480-444-6612
Practice Address - Fax:480-371-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0066733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ08433Medicaid
2155128OtherPK