1679850101 NPI number — YOUR RX PHARMACY INC

Table of content: (NPI 1679850101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679850101 NPI number — YOUR RX PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR RX PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679850101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2637 IRA E WOODS AVE
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-9010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-416-2222
Provider Business Mailing Address Fax Number:
817-416-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2637 IRA E WOODS AVE
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-416-2222
Provider Business Practice Location Address Fax Number:
817-416-2223
Provider Enumeration Date:
11/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
PRAFUL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-457-5571

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  27755 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1679850101 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: D0185339 . This is a "DPS-TEXAS STATE CONTROLLED SUBSTANCE LIC #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 27755 . This is a "RETAIL PHARMACY PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5904431 . This is a "NCPDP/NABP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 146481 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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