MEDICARE: RLS SUPERMARKETS 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	3336C0003X	Community/Retail Pharmacy	29840	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150198	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295772630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RLS SUPERMARKETS LLC

Provider Business Mailing Address
First Line	:	4349 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-3854
Country	:	US
Telephone Number	:	214-357-8195
Fax Number	:	214-357-8208

Provider Business Practice Location Address
First Line	:	4349 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-3854
Country	:	US
Telephone Number	:	214-357-8195
Fax Number	:	214-357-8208

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	JOHN PIPER
Credential	:
Telephone Number	:	972-754-4436

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/19/2016

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Directions to “RLS SUPERMARKETS LLC ” Practice Location

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