Organization
SCPG LOUISIANA LLC
Active
Other names
Express Rx of Lake Providence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. UMAR FAROOQ (PRESIDENT)
(501) 392-8680
Entity
Organization
Contact information
Practice address
302 LAKE ST, LAKE PROVIDENCE, LA 71254-2630
(318) 559-2433
(318) 559-2437
Mailing address
PO BOX 34407 PMB 53760, LITTLE ROCK, AR 72203-4407
(501) 534-4459
(501) 534-4460
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
09/12/2019
Last updated
11/18/2025
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