Organization
DAVID RAINES COMMUNITY HEALTH CENTER INC
Active
Other names
DAVID RAINES COMMUNITY HEALTH CENTERS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE WHITE (CEO)
(318) 227-3342
Entity
Organization
Contact information
Practice address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 227-3355
(318) 227-3356
Mailing address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 227-3355
(318) 227-3356
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.005457-IR
LA
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1233358
—
LA
01
—
2035347
PK
—
Enumeration date
07/25/2006
Last updated
12/22/2016
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