Healthcare Provider Details

I. General information

NPI: 1972722825
Provider Name (Legal Business Name): RX CARE OF LA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH AVE STE A
VIVIAN LA
71082-3209
US

IV. Provider business mailing address

5908 BRECKENRIDGE PARKWAY
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 318-375-3784
  • Fax: 318-375-5009
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY6524
License Number StateLA

VIII. Authorized Official

Name: JESSICA RIVERA
Title or Position: LICENSING SPECIALIST
Credential:
Phone: 813-304-2221