Provider Demographics
NPI:1386799641
Name:CENTER COMMUNITY PHARMACY
Entity type:Organization
Organization Name:CENTER COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-725-9365
Mailing Address - Street 1:2035 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2227
Mailing Address - Country:US
Mailing Address - Phone:707-725-9365
Mailing Address - Fax:707-725-9404
Practice Address - Street 1:2035 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2227
Practice Address - Country:US
Practice Address - Phone:707-725-9365
Practice Address - Fax:707-725-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZD0304303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA304300Medicare ID - Type Unspecified
CA=========Medicare UPIN