=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306793146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUR LEAF RX, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 W 15TH ST STE 320
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-7244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-796-7286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 W 15TH ST STE 320
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-7244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-796-7286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | NABIL HALLAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-473-5357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835C0207X
-----------------------------------------------------
Taxonomy Name | Compounded Sterile Preparations Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------