NPIMap

Organization Active NPI

Red River Pharmacy Services

  • Long Term Care Pharmacy
  • Texarkana, TX
National Provider Identifier
1336225002
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
23886 Issued in TX
Legal business name
RED RIVER PHARMACY SERVICES
Practice address
1327 College Dr
Suite a
Texarkana, TX 75503-3531
Phone
(903) 792-1721
Fax
(903) 792-2241
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jasen Tate Creek, R.PH.
Title
Pharmacist in Charge
Phone
(903) 792-1721

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 23886 TX Primary

Addresses

Primary practice location

1327 College Dr
Suite a
Texarkana, TX 75503-3531

Mailing address

1327 College Dr
Suite a
Texarkana, TX 75503-3531
Phone (903) 792-1721

Other identifiers 1

IdentifierTypeStateIssuer
145562MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Red River Pharmacy Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1336225002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 COLLEGE DR",
            "address_2": "SUITE A",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033531",
            "telephone_number": "903-792-1721",
            "fax_number": "903-792-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 COLLEGE DR",
            "address_2": "SUITE A",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033531",
            "telephone_number": "903-792-1721",
            "fax_number": "903-792-2241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER PHARMACY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "CREEK",
        "authorized_official_first_name": "JASEN",
        "authorized_official_middle_name": "TATE",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "903-792-1721",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "23886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145562",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.