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General NPI Number Information
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NPI Number | 1669594610
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Entity Type | Organization
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Legal Business Name | URBAN REXALL, LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7517 MILITARY PKWY
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City | DALLAS
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State | TX
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Zip | 75227-3950
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Country | US
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Telephone | 214-381-1179
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Fax | 214-381-1237
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Provider Business Mailing Address
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Address Line | 7517 MILITARY PKWY
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City | DALLAS
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State | TX
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Zip | 75227-3950
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Country | US
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Telephone | 214-381-1179
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Fax | 214-381-1237
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT CLEMENS
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Credential | RPH
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Telephone | 972-564-9000
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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 | 21568
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License Number State | TX
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