Provider Demographics
NPI:1184014839
Name:RAYFORD PHARMACY LLC
Entity Type:Organization
Organization Name:RAYFORD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRECE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-549-1883
Mailing Address - Street 1:7623 LOUETTA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7295
Mailing Address - Country:US
Mailing Address - Phone:832-953-2926
Mailing Address - Fax:832-953-2927
Practice Address - Street 1:7623 LOUETTA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7295
Practice Address - Country:US
Practice Address - Phone:832-953-2926
Practice Address - Fax:832-953-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27308333600000X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147101Medicaid