Provider Demographics
NPI:1336230879
Name:CENTRAL PHARMACY-CHESANING, LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY-CHESANING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-410-8581
Mailing Address - Street 1:126 W. BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616
Mailing Address - Country:US
Mailing Address - Phone:989-845-3609
Mailing Address - Fax:989-845-3121
Practice Address - Street 1:126 W. BROAD ST
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616
Practice Address - Country:US
Practice Address - Phone:989-845-3609
Practice Address - Fax:989-845-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301000323183500000X
MI3336C0003X
3336C0003X
MI53010107463336C0003X
FC56084453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2516651Medicaid
MI7592130001Medicare NSC