NPIMap

Organization Active NPI

Pharma340 LLC

Doing business as Community Pharmacy of Lake CIty

  • Community/Retail Pharmacy
  • Lake City, IA
National Provider Identifier
1063971398
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PHARMA340 LLC
Doing business as
Community Pharmacy of Lake CIty
Practice address
1321 W Main St
Lake City, IA 51449-1585
Phone
(712) 464-7281
NPI assigned
Mar 16, 2019
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Steven Donnelly
Title
Vice President
Phone
(210) 441-2036

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1321 W Main St
Lake City, IA 51449-1585

Mailing address

1321 W Main St
Lake City, IA 51449-1585
Phone (712) 830-5443

Other names 1

  • Community Pharmacy of Lake CIty Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190813003360 IA DME Supplier - Pharmacy 2567799505 Practice locations: Lake City, IA
O20190829002201 IA Part B Supplier - Mass Immunization (Roster Biller Only) 2567799505 5 other NPIs on this enrollment
Practice locations: Rockwell City, IA; Sac City, IA; Lake View, IA; Lake City, IA; Dunlap, IA; Gowrie, IA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2182943Pharma340 Dba Community Pharmacy of Lake City1321 W Main St, Lake City, IA 51449Certificate of waiverApr 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pharma340 LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1552694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1063971398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-830-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMA340 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-16",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "210-441-2036"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Pharmacy of Lake CIty",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Pharmacy of Lake CIty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.