Provider Demographics
NPI:1962435156
Name:CENTER CITY PHARMACY, INC
Entity type:Organization
Organization Name:CENTER CITY PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REBHADL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-805-7135
Mailing Address - Street 1:416 CLEMATIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-805-7135
Mailing Address - Fax:561-805-7138
Practice Address - Street 1:416 CLEMATIS ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-805-7135
Practice Address - Fax:561-805-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 21446183500000X
FLPH214463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013628OtherNCPDP #
FLBC9399949OtherDEA REGISTRATION #
FL1013628OtherNCPDP #
FL5726750001Medicare NSC