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General NPI Number Information
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NPI Number | 1487324273
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Entity Type | Organization
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Legal Business Name | REVELES CLINICAL SERVICES
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 580 COMMERCE ST STE 150B
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9214
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Country | US
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Telephone | 817-482-9336
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Fax | 817-476-8559
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Provider Business Mailing Address
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Address Line | 580 COMMERCE ST STE 150B
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9214
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Country | US
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Telephone | 817-482-9336
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Fax | 817-476-8559
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/PRESIDENT
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Name | MR. RKES D STARLING
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Credential | RPH, MBA
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Telephone | 817-846-6499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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