Healthcare Provider Details

I. General information

NPI: 1437197894
Provider Name (Legal Business Name): RLS SUPERMARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 E MOCKINGBIRD LN
DALLAS TX
75214-2406
US

IV. Provider business mailing address

6464 E MOCKINGBIRD LN
DALLAS TX
75214-2406
US

V. Phone/Fax

Practice location:
  • Phone: 214-827-4230
  • Fax: 214-823-6294
Mailing address:
  • Phone: 214-827-4230
  • Fax: 214-823-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29817
License Number StateTX

VIII. Authorized Official

Name: RAM MAGANTI
Title or Position: PHARMACY MANAGER
Credential:
Phone: 972-227-1222