NPIMap

Organization Active NPI

Community Pharmacy LLC

  • Long Term Care Pharmacy
  • Monroe, LA
National Provider Identifier
1790280717
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHY.006459-IR Issued in LA
Legal business name
COMMUNITY PHARMACY LLC
Practice address
2904 Forsythe Ave
Monroe, LA 71201-3610
Phone
(318) 398-2100
Fax
(318) 387-7682
NPI assigned
Mar 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Mr. William Kyle Kiitzke
Title
President
Phone
(318) 398-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PHY.006459-IR LA Primary

Addresses

Primary practice location

2904 Forsythe Ave
Monroe, LA 71201-3610

Mailing address

2904 Forsythe Ave
Monroe, LA 71201-3610
Phone (318) 398-2100

Other identifiers 1

IdentifierTypeStateIssuer
2201174MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1790280717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013610",
            "telephone_number": "318-398-2100",
            "fax_number": "318-387-7682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013610",
            "telephone_number": "318-398-2100",
            "fax_number": "318-387-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-30",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "KIITZKE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-398-2100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "LA",
            "license": "PHY.006459-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2201174",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.