=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679850101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUR RX PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2011
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2637 IRA E WOODS AVE #200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-9010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-416-2222
-----------------------------------------------------
Fax | 817-416-2223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2637 IRA E WOODS AVE #200
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-9010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-416-2222
-----------------------------------------------------
Fax | 817-416-2223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PRAFUL D PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-457-5571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 27755
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------