Montgomery Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY005153IR Issued in LA

Legal business name

MONTGOMERY PHARMACY LLC

Doing business as

Montgomery Pharmacy

Practice address

1101 Caddo St
Montgomery, LA 71454

Phone

(318) 646-6877

Fax

(318) 646-6800

NPI assigned

Nov 11, 2005

Last updated

Jun 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vince Bartley, RPHNPI 1962666198

Title

Owner

Phone

(318) 646-6877

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MONTGOMERY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

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

• Montgomery Pharmacy LLC

  dba Grant Family Pharmacy

  • Community/Retail Pharmacy
  • Bentley, LA
  • NPI 1578702668

  O20150529000522

  Same enrollment

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

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vince L Bartley, RPH

  • Pharmacist
  • Bentley, LA
  • NPI 1962666198
  Authorized official Same address or phone

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1801877287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "MONTGOMERY",
            "state": "LA",
            "postal_code": "714540036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CADDO ST",
            "city": "MONTGOMERY",
            "state": "LA",
            "postal_code": "71454",
            "telephone_number": "318-646-6877",
            "fax_number": "318-646-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "BARTLEY",
        "authorized_official_first_name": "VINCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-646-6877",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY005153IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2035172",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1270989",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONTGOMERY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bartley Enterprise Drug Screening
• Donna Bartley
• BJC Healthcare, LLC (Montgomery Family Clinic)
• Benjamin James Colvin
• Montgomery Clinic LLC
• Tara Sapp
• Winn Community Health Center, Inc.
• Winn Community Health Center, Inc.
• Winn Community Health Center, Inc.

• Community/Retail Pharmacy in Montgomery, LA
• Providers in Montgomery, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.