# SCPG LOUISIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Express Rx of Lake Providence
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700436706
- **Authorized official:** MR. UMAR FAROOQ (PRESIDENT)
- **Authorized official phone:** (501) 392-8680

## Contact information

- **Practice address:** 302 LAKE ST, LAKE PROVIDENCE, LA 71254-2630
- **Practice address phone:** (318) 559-2433
- **Practice address fax:** (318) 559-2437
- **Mailing address:** PO BOX 34407 PMB 53760, LITTLE ROCK, AR 72203-4407
- **Mailing address phone:** (501) 534-4459
- **Mailing address fax:** (501) 534-4460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/12/2019
- **Last updated:** 11/18/2025