MEDICARE: RETAIL INVESTORS OF TEXAS, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	20888	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4579592	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	4579592	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1861568529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETAIL INVESTORS OF TEXAS, LTD.

Provider Business Mailing Address
First Line	:	PO BOX 1717
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-1717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	864 MAGNOLIA AVE
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-3712
Country	:	US
Telephone Number	:	409-722-0411
Fax Number	:	409-727-8986

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SKYLAR THOMPSON
Credential	:
Telephone Number	:	409-749-6405

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	11/02/2015

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