Provider Demographics
NPI:1780398974
Name:CENTER CARE PHARMACY CORP
Entity type:Organization
Organization Name:CENTER CARE PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-737-9697
Mailing Address - Street 1:819 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2410
Mailing Address - Country:US
Mailing Address - Phone:718-737-9697
Mailing Address - Fax:917-830-0314
Practice Address - Street 1:819 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2410
Practice Address - Country:US
Practice Address - Phone:718-737-9697
Practice Address - Fax:917-830-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy