Provider Demographics
NPI:1235212564
Name:CENTERWELL PHARMACY, INC.
Entity Type:Organization
Organization Name:CENTERWELL PHARMACY, INC.
Other - Org Name:PRESCRIBEIT RX - MIRAMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
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 1:10749 MARKS WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3976
Practice Address - Country:US
Practice Address - Phone:800-526-1490
Practice Address - Fax:800-526-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH219093336C0003X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026536500Medicaid
FL028292800Medicaid
FL028294400Medicaid
2015813OtherPK