Provider Demographics
NPI:1720640634
Name:CENTENNIAL PHARMACY SERVICES INCORPORATED
Entity Type:Organization
Organization Name:CENTENNIAL PHARMACY SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DYMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:267-324-5025
Mailing Address - Street 1:1020 N DELAWARE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4334
Mailing Address - Country:US
Mailing Address - Phone:215-850-5701
Mailing Address - Fax:
Practice Address - Street 1:1020 N DELAWARE AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4334
Practice Address - Country:US
Practice Address - Phone:267-534-5025
Practice Address - Fax:267-324-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035739960001Medicaid