Provider Demographics
NPI:1477913937
Name:CENTRAL PHARMACY - WESTSIDE LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY - WESTSIDE LLC
Other - Org Name:CENTRAL PHARMACY - WESTSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/AO
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOAGYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-402-8256
Mailing Address - Street 1:4801 W SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2623
Mailing Address - Country:US
Mailing Address - Phone:517-833-4629
Mailing Address - Fax:517-253-7385
Practice Address - Street 1:4801 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2623
Practice Address - Country:US
Practice Address - Phone:517-505-2990
Practice Address - Fax:517-393-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010108723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158295OtherPK