Provider Demographics
NPI:1770178923
Name:RED RIVER PHARMACY SERVICES INC
Entity type:Organization
Organization Name:RED RIVER PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
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 C
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:903-792-4825
Mailing Address - Fax:844-245-7447
Practice Address - Street 1:1550 MOORES LN STE C
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4657
Practice Address - Country:US
Practice Address - Phone:903-792-4825
Practice Address - Fax:844-245-7447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED RIVER PHARMACY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROS03058OtherBOP LICENSE
TX33498OtherBOP LICENSE