MEDICARE: REVITA RX PLLC

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

General Provider Information

NPI Number	:	1467156695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVITA RX PLLC

Provider Business Mailing Address
First Line	:	1933 E FRANKFORD RD STE 120
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5394
Country	:	US
Telephone Number	:	469-649-9442
Fax Number	:	469-919-4772

Provider Business Practice Location Address
First Line	:	1933 E FRANKFORD RD STE 120
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5394
Country	:	US
Telephone Number	:	972-333-2831
Fax Number	:	214-387-1889

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BEBE S MASUD
Credential	:
Telephone Number	:	303-408-7785

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	01/09/2026

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Directions to “REVITA RX PLLC ” Practice Location

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