Provider Demographics
NPI:1528570785
Name:COMMUNITY CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHARMACY, LLC
Other - Org Name:PHOENIX HOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:833-321-4479
Mailing Address - Street 1:617 N COWLING ST STE H
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-3176
Mailing Address - Country:US
Mailing Address - Phone:833-321-4479
Mailing Address - Fax:573-436-0630
Practice Address - Street 1:617 N COWLING ST STE H
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3176
Practice Address - Country:US
Practice Address - Phone:833-321-4479
Practice Address - Fax:573-436-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy