Provider Demographics
NPI:1710460001
Name:COMMUNITY PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY SERVICES LLC
Other - Org Name:CONSONUS PHARMACY OVERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-206-5172
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-0524
Mailing Address - Country:US
Mailing Address - Phone:402-289-0431
Mailing Address - Fax:844-596-1448
Practice Address - Street 1:509 C ST
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NE
Practice Address - Zip Code:68863-5351
Practice Address - Country:US
Practice Address - Phone:402-289-0431
Practice Address - Fax:844-596-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025934601Medicaid
NE8OtherPHARMACY LICENSE