Healthcare Provider Details

I. General information

NPI: 1093285843
Provider Name (Legal Business Name): MRC HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W FM 544 STE 130
WYLIE TX
75098-4903
US

IV. Provider business mailing address

4008 KINGSWICK DR
ARLINGTON TX
76016-3215
US

V. Phone/Fax

Practice location:
  • Phone: 972-442-5333
  • Fax:
Mailing address:
  • Phone: 817-933-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN CRAIG GOODSON
Title or Position: OFFICER
Credential: PHARM D
Phone: 972-442-5333