Provider Demographics
NPI:1952457418
Name:CENTRAL COMMUNITY PHARMACY, INC.
Entity Type:Organization
Organization Name:CENTRAL COMMUNITY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHARMACIST IN CHARGE, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSAMA (SAM)
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHOKAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-846-1800
Mailing Address - Street 1:2701 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5527
Mailing Address - Country:US
Mailing Address - Phone:323-846-1800
Mailing Address - Fax:323-846-1866
Practice Address - Street 1:2701 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5527
Practice Address - Country:US
Practice Address - Phone:323-846-1800
Practice Address - Fax:323-846-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 47177333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA471770Medicaid