NPIMap

Organization Active NPI

Centerwell Pharmacy, Inc.

  • Pharmacy
  • Live Oak, TX
National Provider Identifier
1508310772
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
30954 Issued in TX
Legal business name
CENTERWELL PHARMACY, INC.
Practice address
12602 Toepperwein Rd
Suite 100
Live Oak, TX 78233-3269
Phone
(210) 672-6510
NPI assigned
Aug 5, 2016
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Sean Lysinger
Title
VP
Phone
(502) 580-2376

Other NPIs with the same Medicare PAC ID 20

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

Corporate family (same tax ID) 46

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

View all 46

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20191009003527 TX Part B Supplier - Pharmacy 9739233743 Practice locations: Live Oak, TX

National Provider Directory

Tax ID family
Humana Pharmacy- Homestead (47 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 30954 TX Primary
Community/Retail Pharmacy 3336C0003X

Addresses

NPPES NPI Registry

Primary practice location

12602 Toepperwein Rd
Suite 100
Live Oak, TX 78233-3269

Mailing address

12602 Toepperwein Rd
Suite 100
Live Oak, TX 78233-3269
Phone (210) 672-6510

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
2162396OtherPK

Other names 1

NPPES NPI Registry
  • Humana Pharmacy, Inc. Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 6, 2026.

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1508310772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12602 TOEPPERWEIN RD",
            "address_2": "SUITE 100",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333269",
            "telephone_number": "210-672-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 TOEPPERWEIN RD",
            "address_2": "SUITE 100",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333269",
            "telephone_number": "210-672-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "LYSINGER",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "502-580-2376"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "30954",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162396",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humana Pharmacy, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Live Oak, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.