Healthcare Provider Details

I. General information

NPI: 1215092325
Provider Name (Legal Business Name): RX CLUB OF AMERICA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHAPEL LANE
NEW BOSTON TX
75570
US

IV. Provider business mailing address

10 MAIN DR
NEW BOSTON TX
75570-9534
US

V. Phone/Fax

Practice location:
  • Phone: 903-223-5229
  • Fax: 903-223-5232
Mailing address:
  • Phone:
  • Fax:

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 Number23954
License Number StateTX

VIII. Authorized Official

Name: JOEL ADAME
Title or Position: PRESIDENT
Credential:
Phone: 281-861-6398