Healthcare Provider Details

I. General information

NPI: 1962337956
Provider Name (Legal Business Name): COMMUNITY CARE PHARMACY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NEW TOWNE DR STE 100
BOWLING GREEN KY
42103-7966
US

IV. Provider business mailing address

340 NEW TOWNE DR STE 100
BOWLING GREEN KY
42103-7966
US

V. Phone/Fax

Practice location:
  • Phone: 270-495-1976
  • Fax:
Mailing address:
  • Phone: 270-495-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KENDALL KILBOURNE
Title or Position: MEMBER/OWNER
Credential: RPH
Phone: 606-309-4662