Provider Demographics
NPI:1851441166
Name:CENTURY PHARMACY INC
Entity Type:Organization
Organization Name:CENTURY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR OF SC
Authorized Official - Phone:310-473-1568
Mailing Address - Street 1:11870 SANTA MONICA BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2212
Mailing Address - Country:US
Mailing Address - Phone:310-473-1568
Mailing Address - Fax:310-820-4451
Practice Address - Street 1:11870 SANTA MONICA BLVD
Practice Address - Street 2:STE 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2276
Practice Address - Country:US
Practice Address - Phone:310-473-1568
Practice Address - Fax:310-820-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY342523336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004373OtherPK
2004373OtherPK
CA7045180001OtherMEDICAID
CA7045180001Medicaid