Healthcare Provider Details

I. General information

NPI: 1013864859
Provider Name (Legal Business Name): FOUR LEAF RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 15TH ST STE 320
PLANO TX
75075-7244
US

IV. Provider business mailing address

1309 W 15TH ST STE 320
PLANO TX
75075-7244
US

V. Phone/Fax

Practice location:
  • Phone: 888-796-7286
  • Fax:
Mailing address:
  • Phone: 888-796-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1400X
TaxonomyPain Management Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: NABIL HALLAK
Title or Position: COO
Credential:
Phone: 469-473-5357