Provider Demographics
NPI:1891148995
Name:RUSTON APOTHECARE
Entity Type:Organization
Organization Name:RUSTON APOTHECARE
Other - Org Name:RUSTON APOTHECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-3223
Mailing Address - Street 1:1680 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6615
Mailing Address - Country:US
Mailing Address - Phone:318-255-3223
Mailing Address - Fax:318-254-0394
Practice Address - Street 1:1680 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6615
Practice Address - Country:US
Practice Address - Phone:318-255-3223
Practice Address - Fax:318-254-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
LAPHY.007365-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162225OtherPK
LA2204700Medicaid