Provider Demographics
NPI:1912613803
Name:RED RIVER PHARMACY CONSULTING, LLC
Entity Type:Organization
Organization Name:RED RIVER PHARMACY CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOMICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:318-697-4381
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-0068
Mailing Address - Country:US
Mailing Address - Phone:318-697-4381
Mailing Address - Fax:318-697-5311
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:LA
Practice Address - Zip Code:71049-2997
Practice Address - Country:US
Practice Address - Phone:318-697-4381
Practice Address - Fax:318-697-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2209353Medicaid