Organization
COMMUNITY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM KYLE KLITZKE (PRESIDENT)
(318) 398-2100
Entity
Organization
Contact information
Practice address
2904 FORSYTHE AVE, MONROE, LA 71201-3610
(318) 398-2100
(318) 387-7682
Mailing address
2904 FORSYTHE AVE, MONROE, LA 71201-3610
(318) 398-2100
(318) 387-7682
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006459-IR
LA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2201174
—
LA
Enumeration date
09/29/2011
Last updated
05/25/2023
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