Healthcare Provider Details

I. General information

NPI: 1184014839
Provider Name (Legal Business Name): RAYFORD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7623 LOUETTA RD SUITE 104
SPRING TX
77379-7295
US

IV. Provider business mailing address

7623 LOUETTA RD SUITE 104
SPRING TX
77379-7295
US

V. Phone/Fax

Practice location:
  • Phone: 832-953-2926
  • Fax: 832-953-2927
Mailing address:
  • Phone: 832-953-2926
  • Fax: 832-953-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number27308
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRECE A JONES
Title or Position: V.P OPERATIONS
Credential: PHARM D
Phone: 832-549-1883