NPIMap

Organization Active NPI

Red River Pharmacy Services Inc

Doing business as Red River Infusion Pharmacy of Texarkana

  • Home Infusion Therapy Pharmacy
  • Texarkana, TX
National Provider Identifier
1356455638
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
18696 Issued in TX
Legal business name
RED RIVER PHARMACY SERVICES INC
Doing business as
Red River Infusion Pharmacy of Texarkana
Practice address
1550 Moores LN Ste D
Texarkana, TX 75503-4657
Phone
(903) 792-7435
Fax
(903) 793-0485
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Authorized official

Name
David Boudreaux, RPH
Title
Owner
Phone
(903) 792-7435

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 18696 TX
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 18696 TX
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Home Infusion Therapy Pharmacy 3336H0001X 18696 TX Primary

Addresses

Primary practice location

1550 Moores LN Ste D
Texarkana, TX 75503-4657

Mailing address

1550 Moores LN
Texarkana, TX 75503-4657
Phone (903) 792-7435

Other identifiers 4

IdentifierTypeStateIssuer
2094045OtherPK
320233MedicaidTX
200003720MedicaidOK
2211226MedicaidLA

Other names 1

  • Red River Infusion Pharmacy of Texarkana Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930053676 TX DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 4486765674 Practice locations: Texarkana, TX

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.

Locations

1550 Moores Ln
Ste D
Texarkana, TX 75503
Phone (903) 792-2753

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1356455638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 MOORES LN",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034657",
            "telephone_number": "903-792-7435",
            "fax_number": "903-793-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 MOORES LN STE D",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034657",
            "telephone_number": "903-792-7435",
            "fax_number": "903-793-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER PHARMACY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-792-7435",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "18696",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "18696",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "TX",
            "license": "18696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2094045",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320233",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200003720",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2211226",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red River Infusion Pharmacy of Texarkana",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Red River Infusion Pharmacy of Texarkana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.