Healthcare Provider Details

I. General information

NPI: 1083060776
Provider Name (Legal Business Name): RX SOS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W NORTHWEST HWY STE H
GRAPEVINE TX
76051-5010
US

IV. Provider business mailing address

1115 W NORTHWEST HWY STE H
GRAPEVINE TX
76051-5010
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-5780
  • Fax: 817-442-0435
Mailing address:
  • Phone: 817-481-5780
  • Fax: 817-442-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number30574
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHELLY MOSS
Title or Position: PRESIDENT
Credential:
Phone: 817-481-5780