Provider Demographics
NPI:1497196851
Name:RED RIVER RX SOLUTIONS, LLC
Entity Type:Organization
Organization Name:RED RIVER RX SOLUTIONS, LLC
Other - Org Name:RED RIVER RX SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-509-2952
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-1160
Mailing Address - Country:US
Mailing Address - Phone:405-509-2952
Mailing Address - Fax:405-509-2984
Practice Address - Street 1:125 E 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3822
Practice Address - Country:US
Practice Address - Phone:405-509-2952
Practice Address - Fax:405-509-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-6361333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy