Provider Demographics
NPI:1861503914
Name:CENTAURA PHARMACY INC
Entity Type:Organization
Organization Name:CENTAURA PHARMACY INC
Other - Org Name:NADIA'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-584-7272
Mailing Address - Street 1:12818 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1533
Mailing Address - Country:US
Mailing Address - Phone:313-584-7272
Mailing Address - Fax:313-584-7737
Practice Address - Street 1:12818 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1533
Practice Address - Country:US
Practice Address - Phone:313-584-7272
Practice Address - Fax:313-584-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2653875Medicaid
MI5275780001Medicare ID - Type Unspecified