Provider Demographics
NPI:1235154725
Name:CENTERWELL PHARMACY, INC.
Entity Type:Organization
Organization Name:CENTERWELL PHARMACY, INC.
Other - Org Name:HUMANA PHARMACY, INC. 05041
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLLBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-580-1000
Mailing Address - Street 1:10749 MARKS WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3976
Mailing Address - Country:US
Mailing Address - Phone:800-526-1489
Mailing Address - Fax:800-526-1491
Practice Address - Street 1:1651 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5903
Practice Address - Country:US
Practice Address - Phone:561-966-1052
Practice Address - Fax:561-966-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH265513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012239OtherPK
FL011698900Medicaid