Provider Demographics
NPI:1851337760
Name:CENTRAL PHARMACY-OWOSSO LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY-OWOSSO LLC
Other - Org Name:CENTRAL PHARMACY-OWOSSO LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:517-410-8581
Mailing Address - Street 1:111 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2819
Mailing Address - Country:US
Mailing Address - Phone:989-725-1344
Mailing Address - Fax:989-729-0109
Practice Address - Street 1:111 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2819
Practice Address - Country:US
Practice Address - Phone:989-725-1344
Practice Address - Fax:989-729-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010105673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4073892Medicaid
2147805OtherPK
MI7235550001Medicare NSC