Provider Demographics
NPI:1093321812
Name:COMMUNITY PHARMACY OF STERLINGTON
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF STERLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:KLITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-381-9091
Mailing Address - Street 1:2123 FORSYTHE AVE
Mailing Address - Street 2:ATTN: CP STERLINGTON
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3610
Mailing Address - Country:US
Mailing Address - Phone:318-398-2100
Mailing Address - Fax:
Practice Address - Street 1:200 SCOTT DR
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280
Practice Address - Country:US
Practice Address - Phone:318-667-0197
Practice Address - Fax:318-667-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy