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General NPI Number Information
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NPI Number | 1609323922
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Entity Type | Organization
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Legal Business Name | RED RIVER PHARMACY OF JONESBORO LLC
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2908 S CARAWAY RD
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City | JONESBORO
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State | AR
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Zip | 72401-7346
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Country | US
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Telephone | 870-336-2195
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Fax | 870-336-2197
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Provider Business Mailing Address
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Address Line | 1550 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-4657
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Country | US
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Telephone | 903-792-7435
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Fax | 903-793-0485
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID BOUDREAUX
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Credential |
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Telephone | 903-792-7435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | AR20653
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number |
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License Number State |
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