Provider Demographics
NPI:1568090231
Name:RAYNE MEDICINE SHOPPE, INC
Entity type:Organization
Organization Name:RAYNE MEDICINE SHOPPE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:337-230-2102
Mailing Address - Street 1:913 THE BLVD
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578
Mailing Address - Country:US
Mailing Address - Phone:337-334-3399
Mailing Address - Fax:337-334-3339
Practice Address - Street 1:913 THE BLVD
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-6134
Practice Address - Country:US
Practice Address - Phone:337-334-3399
Practice Address - Fax:337-334-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2204564Medicaid