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General NPI Number Information
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NPI Number | 1437600392
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Entity Type | Organization
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Legal Business Name | REVIVE RX LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3831 GOLF DR STE A
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City | HOUSTON
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State | TX
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Zip | 77018-5218
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Country | US
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Telephone | 888-689-2271
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Fax | 888-689-1620
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Provider Business Mailing Address
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Address Line | 3831 GOLF DR STE A
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City | HOUSTON
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State | TX
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Zip | 77018-5218
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Country | US
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Telephone | 888-689-2271
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Fax | 888-689-1620
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Authorized Official
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Title or Position | OWNER
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Name | AARON MICHAEL SCHNEIDER
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Credential |
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Telephone | 888-689-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | OSP.0006854
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30363
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | Y006974
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 2016042826
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 30984
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License Number State | TX
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