Healthcare Provider Details

I. General information

NPI: 1598618258
Provider Name (Legal Business Name): RUSTONRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N TRENTON ST
RUSTON LA
71270-4324
US

IV. Provider business mailing address

200 N TRENTON ST
RUSTON LA
71270-4324
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-2840
  • Fax: 318-224-2842
Mailing address:
  • Phone: 318-224-2840
  • Fax: 318-224-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LATEEF ODEYEMI
Title or Position: OWNER
Credential:
Phone: 318-243-4748