Provider Demographics
NPI:1851097794
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 LTC OF LITTLE ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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
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:903-792-1721
Mailing Address - Fax:
Practice Address - Street 1:1515 S BOWMAN RD STE D
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4227
Practice Address - Country:US
Practice Address - Phone:501-712-4582
Practice Address - Fax:833-701-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy