Provider Demographics
NPI:1760736979
Name:CENTRAL PHARMACY GROUP INC.
Entity Type:Organization
Organization Name:CENTRAL PHARMACY GROUP INC.
Other - Org Name:1ST AID PHARMACY & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-450-3555
Mailing Address - Street 1:23 W FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5304
Mailing Address - Country:US
Mailing Address - Phone:718-450-3555
Mailing Address - Fax:718-450-3155
Practice Address - Street 1:23 W FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5304
Practice Address - Country:US
Practice Address - Phone:718-450-3555
Practice Address - Fax:718-450-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0315233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03510538Medicaid
NY6716660001Medicare NSC