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General NPI Number Information
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NPI Number | 1336225002
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Entity Type | Organization
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Legal Business Name | RED RIVER PHARMACY SERVICES
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 1327 COLLEGE DR SUITE A
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City | TEXARKANA
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State | TX
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Zip | 75503-3531
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Country | US
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Telephone | 903-792-1721
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Fax | 903-792-2241
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Provider Business Mailing Address
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Address Line | 1327 COLLEGE DR SUITE A
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City | TEXARKANA
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State | TX
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Zip | 75503-3531
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Country | US
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Telephone | 903-792-1721
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Fax | 903-792-2241
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. JASEN TATE CREEK
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Credential | R.PH.
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Telephone | 903-792-1721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 23886
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License Number State | TX
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