Provider Demographics
NPI:1730625716
Name:CENTERWELL PHARMACY, INC.
Entity type:Organization
Organization Name:CENTERWELL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLLBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-580-1000
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3461
Mailing Address - Country:US
Mailing Address - Phone:561-227-1482
Mailing Address - Fax:
Practice Address - Street 1:4849 LAKE WORTH RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3462
Practice Address - Country:US
Practice Address - Phone:561-227-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH30540333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167038OtherPK