Provider Demographics
NPI:1386600641
Name:CENTRACARE PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:CENTRACARE PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR RETAIL PHARM. SE
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-251-2700
Mailing Address - Street 1:1555 NORTHWAY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4555
Mailing Address - Country:US
Mailing Address - Phone:320-240-3160
Mailing Address - Fax:320-255-5876
Practice Address - Street 1:1555 NORTHWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4912
Practice Address - Country:US
Practice Address - Phone:320-240-3160
Practice Address - Fax:320-255-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2610813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047034OtherPK
MN649822100Medicaid
0968910001Medicare NSC