Provider Demographics
NPI:1033508544
Name:RAYS PHARMACY ON VERSAILLES LLC
Entity Type:Organization
Organization Name:RAYS PHARMACY ON VERSAILLES LLC
Other - Org Name:RAY PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-619-7772
Mailing Address - Street 1:4629 SHREVEPORT HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3830
Mailing Address - Country:US
Mailing Address - Phone:318-640-5882
Mailing Address - Fax:318-640-8784
Practice Address - Street 1:4629 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-3830
Practice Address - Country:US
Practice Address - Phone:318-640-5882
Practice Address - Fax:318-640-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
LAPHY007049IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149839OtherPK
LA2203282Medicaid