Provider Demographics
NPI:1265286348
Name:COMMUNITY CARE PHARMACY, L.L.C.
Entity type:Organization
Organization Name:COMMUNITY CARE PHARMACY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KILBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-348-1985
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0413
Mailing Address - Country:US
Mailing Address - Phone:606-309-4662
Mailing Address - Fax:
Practice Address - Street 1:126 FRANKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2245
Practice Address - Country:US
Practice Address - Phone:606-348-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy