Provider Demographics
NPI:1417946062
Name:CENTRAL MEDICAL ARTS PHARMACY
Entity Type:Organization
Organization Name:CENTRAL MEDICAL ARTS PHARMACY
Other - Org Name:CMA PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:216-621-9073
Mailing Address - Street 1:2475 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3221
Mailing Address - Country:US
Mailing Address - Phone:216-621-9073
Mailing Address - Fax:216-621-9685
Practice Address - Street 1:2475 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3221
Practice Address - Country:US
Practice Address - Phone:216-621-9073
Practice Address - Fax:216-621-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02163550333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408848Medicaid
OH0212450001Medicare NSC