Provider Demographics
NPI:1902284540
Name:CENTRAL PHARMACY-EAST LLC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY-EAST LLC
Other - Org Name:CENTRAL PHARMACY-EAST, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSEIBEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-574-3434
Mailing Address - Street 1:4248 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2012
Mailing Address - Country:US
Mailing Address - Phone:810-744-9101
Mailing Address - Fax:810-744-9151
Practice Address - Street 1:4248 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2012
Practice Address - Country:US
Practice Address - Phone:810-744-9101
Practice Address - Fax:810-744-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151933OtherPK
MI1902284540Medicaid