NPIMap

Organization Active NPI

Centralia Pharmacy Group, Inc.

Doing business as Centralia Pharmacy

  • Community/Retail Pharmacy
  • Centralia, WA
National Provider Identifier
1336686039
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CENTRALIA PHARMACY GROUP, INC.
Doing business as
Centralia Pharmacy
Practice address
417 S Tower Ave
Centralia, WA 98531-3917
Phone
(360) 736-5000
Fax
(360) 736-9433
NPI assigned
Jan 19, 2017
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Jeff Harrell, PHARMD
Title
President
Phone
(360) 244-5984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

417 S Tower Ave
Centralia, WA 98531-3917

Mailing address

PO Box B
Ilwaco, WA 98624-0167
Phone (360) 244-5984

Other identifiers 2

IdentifierTypeStateIssuer
2077225MedicaidWA
G8965128OtherWAPTAN

Other names 1

  • Centralia Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170503001716 WA Part B Supplier - Mass Immunization (Roster Biller Only) 8022395888 Practice locations: Centralia, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Centralia Pharmacy Group Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

417 S Tower Ave
Centralia, WA 98531
Phone (360) 736-4433

NPI Registry JSON

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1336686039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX B",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240167",
            "telephone_number": "360-244-5984",
            "fax_number": "888-788-5384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S TOWER AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985313917",
            "telephone_number": "360-736-5000",
            "fax_number": "360-736-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRALIA PHARMACY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-244-5984",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2077225",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "G8965128",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centralia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centralia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.