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Organization
POLKS CROSSGATES DISCOUNT DRUGS INC
Active
Organization
POLKS CROSSGATES DISCOUNT DRUGS INC
Active
Other names
PMO PHARMACY MANAGEMENT SHREVEPORT
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RICHARD GRAY JR. (PIC)
(318) 429-0161
Entity
Organization
Contact information
Practice address
2255 WOODWARD AVE, SHREVEPORT, LA 71103-3547
(318) 429-0161
(318) 429-0163
Mailing address
2255 WOODWARD AVE, SHREVEPORT, LA 71103-3547
(318) 429-0161
(318) 429-0163
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
5223
LA
3336C0003X
Community/Retail Pharmacy
Primary
5223
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1271357
—
LA
05
—
200022580A
—
OK
05
—
580101
—
TX
Enumeration date
09/15/2006
Last updated
10/07/2025
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