Healthcare Provider Details

I. General information

NPI: 1447048863
Provider Name (Legal Business Name): GWEN RUTH SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 04/26/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S JOHN REDDITT DR
LUFKIN TX
75904-3120
US

IV. Provider business mailing address

236 NORRIS RD
CHOUDRANT LA
71227-3102
US

V. Phone/Fax

Practice location:
  • Phone: 936-637-8643
  • Fax:
Mailing address:
  • Phone: 318-245-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013781
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: