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General NPI Number Information
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NPI Number | 1417870072
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Entity Type | Organization
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Legal Business Name | REJUVENATION PHARMACY INCORPORATED LLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1550 NORWOOD DR STE 300
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City | HURST
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State | TX
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Zip | 76054-3653
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Country | US
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Telephone | 281-336-9927
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Fax | 281-335-6645
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Provider Business Mailing Address
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Address Line | 1550 NORWOOD DR STE 300
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City | HURST
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State | TX
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Zip | 76054-3653
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Country | US
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Telephone | 281-336-9927
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Fax | 281-335-6645
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Authorized Official
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Title or Position | CHIEF PHARMACY OFFICER
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Name | DR. CHRISTOPHER VARD TYRONE II
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Credential | PHARMD
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Telephone | 682-438-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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