# RED RIVER PHARMACY LONG TERM CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Red River LTC of Tyler
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447500590
- **Authorized official:** MR. DAVID BOUDREAUX (PRESIDENT/OWNER)
- **Authorized official phone:** (903) 792-1721

## Contact information

- **Practice address:** 4801 TROUP HWY, SUITE 402, TYLER, TX 75703-2356
- **Practice address phone:** (903) 617-6885
- **Practice address fax:** (844) 308-8629
- **Mailing address:** 1550 MOORES LN STE A, TEXARKANA, TX 75503-4657
- **Mailing address phone:** (903) 617-6885
- **Mailing address fax:** (903) 617-6972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 28138 | TX | Yes |

## Other

- **Enumeration date:** 09/17/2012
- **Last updated:** 05/31/2022