Provider Demographics
NPI:1275259863
Name:CENTRAL CARE PHARMACY LLC
Entity Type:Organization
Organization Name:CENTRAL CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-506-3868
Mailing Address - Street 1:100 LONGBOAT AVE
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722
Mailing Address - Country:US
Mailing Address - Phone:732-506-3868
Mailing Address - Fax:732-506-3392
Practice Address - Street 1:100 LONGBOAT AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722
Practice Address - Country:US
Practice Address - Phone:732-506-3868
Practice Address - Fax:732-506-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0882119Medicaid