Provider Demographics
NPI:1497767990
Name:CENTRAL PHARMACY INC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-652-2651
Mailing Address - Street 1:990 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-2024
Mailing Address - Country:US
Mailing Address - Phone:701-652-2651
Mailing Address - Fax:701-652-1882
Practice Address - Street 1:990 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2024
Practice Address - Country:US
Practice Address - Phone:701-652-2651
Practice Address - Fax:701-652-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NDPHAR7863336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3502146OtherNCPDP
ND3502146OtherNCPDP