Provider Demographics
NPI:1508486226
Name:CENTENO, OSMIN
Entity Type:Individual
Prefix:DR
First Name:OSMIN
Middle Name:
Last Name:CENTENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MEGAN CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2225
Mailing Address - Country:US
Mailing Address - Phone:216-244-6195
Mailing Address - Fax:
Practice Address - Street 1:3460 PUMP RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1111
Practice Address - Country:US
Practice Address - Phone:804-253-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist