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General NPI Number Information
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NPI Number | 1265538664
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Entity Type | Organization
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Legal Business Name | POLKS CROSSGATES DISCOUNT DRUGS INC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2255 WOODWARD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71103-3547
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Country | US
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Telephone | 318-429-0161
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Fax | 318-429-0163
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Provider Business Mailing Address
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Address Line | 2255 WOODWARD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71103-3547
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Country | US
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Telephone | 318-429-0161
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Fax | 318-429-0163
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Authorized Official
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Title or Position | PIC
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Name | JOHN RICHARD GRAY JR.
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Credential |
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Telephone | 318-429-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5223
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5223
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License Number State | LA
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