Centreville Drugs Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

P04614 Issued in MD

Legal business name

CENTREVILLE DRUGS INC

Practice address

102 Commerce Street
Centreville, MD 21617

Phone

(410) 758-1715

Fax

(410) 758-3112

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shalendra Cherukuri, RPH

Title

Vice President

Phone

(410) 758-1715

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• EDWARDS PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MD2 enrollments

Enrollment records 2

Tax ID family

Centreville Drugs Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Centreville Drugs Inc

  • Long Term Care Pharmacy
  • Centreville, MD
  • NPI 1740041631
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Franklin Dolan Edwards, R.PH

  • Pharmacist
  • Centreville, MD
  • NPI 1356493134
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1184723942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S COMMERCE ST",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216171116",
            "telephone_number": "410-758-1715",
            "fax_number": "410-758-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 COMMERCE STREET",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "21617",
            "telephone_number": "410-758-1715",
            "fax_number": "410-758-3112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTREVILLE DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "CHERUKURI",
        "authorized_official_first_name": "SHALENDRA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-758-1715",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "P04614",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013917300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2104913",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDWARDS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EDWARDS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlyn Cardwell, RN
• Wendy Carpenter
• Erin Elizabeth Caughey
• Emma Caulk
• Centreville Chiropractic Center
• Centreville Drugs Inc
• Certified Counseling Services of Centreville, LLC
• Tina L Champagne-George
• Kathleen Chandler
• Andrea Cheezum, ALCOHOL/DRUG TRAINEE

• Pharmacy in Centreville, MD
• Providers in Centreville, MD by specialty
• Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.