Provider Demographics
NPI:1427471895
Name:CENTRAL CARE PHARMACY LLC
Entity type:Organization
Organization Name:CENTRAL CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAJEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-409-7801
Mailing Address - Street 1:12526 ZUMBROTA STREET NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449
Mailing Address - Country:US
Mailing Address - Phone:765-409-7801
Mailing Address - Fax:
Practice Address - Street 1:2336 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3710
Practice Address - Country:US
Practice Address - Phone:612-338-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2648413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1427471895Medicaid