NPIMap

Organization Active NPI

Centerville Village Pharmacy

  • Community/Retail Pharmacy
  • Centreville, MI
National Provider Identifier
1508953795
Registry record updated Apr 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301007448 Issued in MI
Legal business name
CENTERVILLE VILLAGE PHARMACY
Doing business as
Centerville Village Pharmacy
Practice address
666 E Main St
Centreville, MI 49032-9803
Phone
(269) 467-6354
Fax
(269) 467-8503
NPI assigned
Oct 7, 2006
Last updated
Apr 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2010

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

Authorized official

Name
Charles Thompson, PHARMACIST
Title
Pharmacist
Phone
(269) 467-6354

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 5301007448 MI Primary

Addresses

Primary practice location

666 E Main St
Centreville, MI 49032-9803

Mailing address

PO Box 547
Centreville, MI 49032-0547
Phone (269) 467-6354

Other identifiers 2

IdentifierTypeStateIssuer
2354861MedicaidMI
2354861OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • CENTERVILLE VILLAGE PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Village Pharmacy6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272499200000",
    "number": "1508953795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490320547",
            "telephone_number": "269-467-6354",
            "fax_number": "269-467-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "666 E MAIN ST",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490329803",
            "telephone_number": "269-467-6354",
            "fax_number": "269-467-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE VILLAGE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2010-04-29",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "269-467-6354",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2354861",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2354861",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTERVILLE VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centreville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.