Provider Demographics
NPI:1508610601
Name:CENTRAL PHARMACY- EATON RAPIDS, LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY- EATON RAPIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:MOHAMAD
Authorized Official - Last Name:KRAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-465-9656
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1068
Mailing Address - Country:US
Mailing Address - Phone:517-663-6811
Mailing Address - Fax:517-663-1732
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1068
Practice Address - Country:US
Practice Address - Phone:517-663-6811
Practice Address - Fax:517-663-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy