Rawls Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Mount Hermon, LA
NPI 1104131549 · NPPES record last updated Oct 15, 2014
Key facts
- NPI
- 1104131549
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY.006306-IR (LA)
- Legal business name
- RAWLS PHARMACY LLC
- Practice address
- 36009 Highway 38
Mount Hermon, LA 70450-6534 - Phone
- (985) 877-4700
- Fax
- (985) 877-4701
- NPI assigned
- Aug 10, 2010
- Organization subpart
- No
Authorized official
- Name
- Jeremy Rawls
- Title
- Pharmacist
- Phone
- (985) 877-4700
Practitioners 2
-
Jeremy Randel Rawls, PHARM.D.
-
Tonia Barker, PHARMACIST
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2208471 | Rawls Pharmacy, LLC | Certificate of waiver | Jan 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170621002652 | LA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1759659444 | Practice locations: Mount Hermon, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY.006306-IR | LA | Yes |
Addresses
Primary practice location
36009 Highway 38
Mount Hermon, LA 70450-6534
Mailing address
36009 Highway 38
Mount Hermon, LA 70450-6534
Phone (985) 877-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2200399 | Medicaid | LA | |
| 2126770 | Other | PK |
Other names
- Rawls Pharmacy
Other providers in Mount Hermon, LA
All providers in Mount Hermon, LA · Community/Retail Pharmacy in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.