Healthcare Provider Details

I. General information

NPI: 1528097581
Provider Name (Legal Business Name): RLS SUPERMARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WILLIAM D TATE AVE
GRAPEVINE TX
76051-8752
US

IV. Provider business mailing address

4000 WILLIAM D TATE AVE
GRAPEVINE TX
76051-8752
US

V. Phone/Fax

Practice location:
  • Phone: 817-684-9211
  • Fax: 817-684-9215
Mailing address:
  • Phone: 817-684-9211
  • Fax: 817-684-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29912
License Number StateTX

VIII. Authorized Official

Name: JOHN PIPER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 972-754-4436