Healthcare Provider Details

I. General information

NPI: 1295166254
Provider Name (Legal Business Name): RUSTON WELLNESS & COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N TRENTON ST # 2
RUSTON LA
71270-4321
US

IV. Provider business mailing address

109 N TRENTON ST STE 2
RUSTON LA
71270-4373
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-8106
  • Fax: 318-254-0461
Mailing address:
  • Phone: 318-255-8106
  • Fax: 318-254-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. LAUREN GOOD
Title or Position: OWNER
Credential: PHARM D
Phone: 318-255-8106