Healthcare Provider Details

I. General information

NPI: 1205940285
Provider Name (Legal Business Name): AINSWORTH PHARMACY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WASHINGTON ST
BASTROP LA
71220-5035
US

IV. Provider business mailing address

604 S WASHINGTON ST
BASTROP LA
71220-5035
US

V. Phone/Fax

Practice location:
  • Phone: 318-281-1537
  • Fax: 318-281-7497
Mailing address:
  • Phone: 318-281-1537
  • Fax: 318-281-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD EUGENE AINSWORTH
Title or Position: OWNER
Credential: PHARMD
Phone: 318-281-1537