Provider Demographics
NPI:1508310772
Name:CENTERWELL PHARMACY, INC.
Entity Type:Organization
Organization Name:CENTERWELL PHARMACY, INC.
Other - Org Name:HUMANA PHARMACY, INC.
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 1:12602 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3269
Mailing Address - Country:US
Mailing Address - Phone:210-672-6510
Mailing Address - Fax:
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-672-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30954333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162396OtherPK