Healthcare Provider Details

I. General information

NPI: 1639255565
Provider Name (Legal Business Name): RLS SUPERMARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 LAKE JUNE RD
DALLAS TX
75217-3002
US

IV. Provider business mailing address

DEPT. D8020 PO BOX 650002
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 972-289-9083
  • Fax: 972-289-9091
Mailing address:
  • Phone: 325-277-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number27546
License Number StateTX

VIII. Authorized Official

Name: RAY SCHALEK
Title or Position: MANAGING OFFICER
Credential:
Phone: 325-277-3524