Provider Demographics
NPI:1497317366
Name:RED RIVER PHARMACY LONG TERM CARE, LLC
Entity Type:Organization
Organization Name:RED RIVER PHARMACY LONG TERM CARE, LLC
Other - Org Name:RED RIVER INFUSION PHARMACY OF TYLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-7435
Mailing Address - Street 1:1550 MOORES LN STE A
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4801 TROUP HWY STE 401
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2358
Practice Address - Country:US
Practice Address - Phone:903-617-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition