Healthcare Provider Details

I. General information

NPI: 1790135309
Provider Name (Legal Business Name): TURNER REXALL 1136 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E MAIN ST
OAK GROVE LA
71263-2552
US

IV. Provider business mailing address

411 E MAIN ST
OAK GROVE LA
71263-2552
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-4205
  • Fax: 318-428-4207
Mailing address:
  • Phone: 318-428-4205
  • Fax: 318-428-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number7327
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7327
License Number StateLA

VIII. Authorized Official

Name: CHRISTOPHER L TURNER
Title or Position: OWNER
Credential:
Phone: 318-428-4205