Provider Demographics
NPI:1154655322
Name:COMPLETE RPH RX SERVICES
Entity Type:Organization
Organization Name:COMPLETE RPH RX SERVICES
Other - Org Name:PLATINUM RX NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DETRA
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-227-1010
Mailing Address - Street 1:5627 ALDINE BENDER RD STE 7
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-4534
Mailing Address - Country:US
Mailing Address - Phone:281-227-1010
Mailing Address - Fax:281-227-1015
Practice Address - Street 1:5627 ALDINE BENDER RD STE 7
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-4534
Practice Address - Country:US
Practice Address - Phone:281-227-1010
Practice Address - Fax:281-227-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29039333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148226Medicaid
2146399OtherPK