Healthcare Provider Details

I. General information

NPI: 1417870072
Provider Name (Legal Business Name): REJUVENATION PHARMACY INCORPORATED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NORWOOD DR STE 300
HURST TX
76054-3653
US

IV. Provider business mailing address

1550 NORWOOD DR STE 300
HURST TX
76054-3653
US

V. Phone/Fax

Practice location:
  • Phone: 281-336-9927
  • Fax: 281-335-6645
Mailing address:
  • Phone: 281-336-9927
  • Fax: 281-335-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER VARD TYRONE II
Title or Position: CHIEF PHARMACY OFFICER
Credential: PHARMD
Phone: 682-438-2904