Provider Demographics
NPI:1194093401
Name:RED RIVER PHARMACY SERVICES INC
Entity type:Organization
Organization Name:RED RIVER PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-792-7435
Mailing Address - Street 1:1550 MOORES LN STE B
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4657
Mailing Address - Country:US
Mailing Address - Phone:903-792-7435
Mailing Address - Fax:903-793-0485
Practice Address - Street 1:1550 MOORES LN STE B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4657
Practice Address - Country:US
Practice Address - Phone:903-792-7435
Practice Address - Fax:903-793-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33819OtherSTATE BOARD OF PHARMACY