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
Update your record
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