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NPI Code Detail

MEDICARE: AYDIL RX SERVICES, LLC

MEDICARE: AYDIL RX SERVICES, 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
13336C0004XCompounding Pharmacy
23336L0003XLong Term Care Pharmacy
33336S0011XSpecialty Pharmacy
43336C0003XCommunity/Retail Pharmacy29403TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12146060OTHERPK

General Provider Information

NPI Number : 1659780302
Entity Type Code : Organization
Provider Name (Legal Business Name) : AYDIL RX SERVICES, LLC
Provider Business Mailing Address
First Line : 1440 GARDENIA ST
Second Line :
City : IRVING
State : TX
Zip : 75063-4232
Country : US
Telephone Number : 972-839-0724
Fax Number :
Provider Business Practice Location Address
First Line : 3001 JOE RAMSEY BLVD E
Second Line :
City : GREENVILLE
State : TX
Zip : 75401-7714
Country : US
Telephone Number : 903-455-7200
Fax Number : 903-455-7300
Authorized Official
Title or Position : MANAGING MEMBER
Name : VIMAL BHAKTA
Credential : RPH
Telephone Number : 972-839-0724
Provider Enumeration Date : 08/07/2014
Last Update Date : 01/10/2021

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Directions to “AYDIL RX SERVICES, LLC ” Practice Location

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