Provider Demographics
NPI:1326376542
Name:REAGANS RX COMPOUNDING PHARMACY AND HOME CARE LLC
Entity Type:Organization
Organization Name:REAGANS RX COMPOUNDING PHARMACY AND HOME CARE LLC
Other - Org Name:REAGAN'S RX COMPOUNDING PHARMACY & HOME CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-382-7948
Mailing Address - Street 1:1118 HOMER RD STE G
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3028
Mailing Address - Country:US
Mailing Address - Phone:318-382-7948
Mailing Address - Fax:318-382-4924
Practice Address - Street 1:1118 HOMER RD STE G
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3028
Practice Address - Country:US
Practice Address - Phone:318-382-7948
Practice Address - Fax:318-382-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-28
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
LAPHY.006248-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124910OtherPK
LA2200038Medicaid
LA2200038Medicaid