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	27837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2130859	OTHER		PK

General Provider Information

NPI Number	:	1477630333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RLS SUPERMARKETS LLC

Provider Business Mailing Address
First Line	:	DEPT. D8020
Second Line	:	PO BOX 650002
City	:	DALLAS
State	:	TX
Zip	:	75265-0002
Country	:	US
Telephone Number	:	325-277-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 W SHADY GROVE RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75060-5056
Country	:	US
Telephone Number	:	972-790-3753
Fax Number	:	972-790-3119

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	RAY SCHALEK
Credential	:
Telephone Number	:	325-277-3524

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/20/2016

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Directions to “RLS SUPERMARKETS LLC ” Practice Location

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