MEDICARE: PREFERRED RX 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	3336L0003X	Long Term Care Pharmacy	25230	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	2098612	OTHER		PK

General Provider Information

NPI Number	:	1629199161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED RX LLC

Provider Business Mailing Address
First Line	:	1221 CORPORATE DR E
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6105
Country	:	US
Telephone Number	:	817-385-4707
Fax Number	:	817-385-4710

Provider Business Practice Location Address
First Line	:	1221 CORPORATE DR E
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6105
Country	:	US
Telephone Number	:	817-385-4707
Fax Number	:	817-385-4710

Authorized Official
Title or Position	:	OFFICER
Name	:	CARY ROSSEL
Credential	:
Telephone Number	:	214-888-8099

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/28/2016

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Directions to “PREFERRED RX LLC ” Practice Location

Language	Start Address	Practice Location

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