Provider Demographics
NPI:1063624328
Name:COMMUNITY PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-206-5172
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-0524
Mailing Address - Country:US
Mailing Address - Phone:402-289-0431
Mailing Address - Fax:402-289-0436
Practice Address - Street 1:21689 NORTHSTAR DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4941
Practice Address - Country:US
Practice Address - Phone:402-289-0431
Practice Address - Fax:402-289-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NE2943336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025934600Medicaid
NE3208OtherPHARMACY LICENSE
IA103459Medicaid