Provider Demographics
NPI:1679515456
Name:SENTER PHARMACY INC
Entity Type:Organization
Organization Name:SENTER PHARMACY INC
Other - Org Name:SENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-482-9167
Mailing Address - Street 1:2643 SENTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1184
Mailing Address - Country:US
Mailing Address - Phone:408-287-4899
Mailing Address - Fax:408-287-4898
Practice Address - Street 1:2643 SENTER RD STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1184
Practice Address - Country:US
Practice Address - Phone:408-287-4899
Practice Address - Fax:408-228-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY473203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114965OtherPK
CAPHA473200Medicaid
7431770001Medicare NSC