Provider Demographics
NPI:1679996490
Name:CENTRAL PHARMACY--LAINGSBURG, LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY--LAINGSBURG, LLC
Other - Org Name:CENTRAL PHARMACY - LAINGSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-651-1777
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-0310
Mailing Address - Country:US
Mailing Address - Phone:517-651-1777
Mailing Address - Fax:517-651-1779
Practice Address - Street 1:209 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9759
Practice Address - Country:US
Practice Address - Phone:517-657-1777
Practice Address - Fax:517-651-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010102643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143855OtherPK