MEDICARE: PERRONERX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy	26901	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2125004	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073830386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRONERX LLC

Provider Business Mailing Address
First Line	:	3923 HIGHWAY 377
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7802
Country	:	US
Telephone Number	:	817-737-7663
Fax Number	:	817-731-7711

Provider Business Practice Location Address
First Line	:	3923 HIGHWAY 377
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7802
Country	:	US
Telephone Number	:	817-731-5899
Fax Number	:	817-731-3069

Authorized Official
Title or Position	:	MANAGING MEMBER/CEO
Name	:	PAULA PERRONE
Credential	:
Telephone Number	:	817-737-7663

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	10/26/2021

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Directions to “PERRONERX LLC ” Practice Location

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