=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326496779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS HEALTH RX, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2016
-----------------------------------------------------
Last Update Date | 05/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 E MAIN ST
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-458-0270
-----------------------------------------------------
Fax | 877-919-9331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 E MAIN ST
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-458-0270
-----------------------------------------------------
Fax | 877-919-9331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | MR. THANH QUANG NGO
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 817-458-0270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28861
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------