Provider Demographics
NPI:1386403194
Name:CENTRAL PHARMACY - MAPLE VALLEY LLC
Entity type:Organization
Organization Name:CENTRAL PHARMACY - MAPLE VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED SHERIF
Authorized Official - Middle Name:HOSSAM
Authorized Official - Last Name:SAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-405-2375
Mailing Address - Street 1:219 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49073-9577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:MI
Practice Address - Zip Code:49073-9577
Practice Address - Country:US
Practice Address - Phone:517-615-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy