Provider Demographics
NPI:1932135126
Name:CENTRAL PHARMACY-PERRY LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY-PERRY LLC
Other - Org Name:CENTRAL PHARMACY-PERRY
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-0105
Mailing Address - Country:US
Mailing Address - Phone:517-625-8640
Mailing Address - Fax:517-625-8642
Practice Address - Street 1:150 S. MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9703
Practice Address - Country:US
Practice Address - Phone:517-625-8640
Practice Address - Fax:517-625-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010105683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147807OtherPK
MI68097549363Medicaid
1263670001Medicare NSC