Provider Demographics
NPI:1285189076
Name:REVIVE RX LLC
Entity Type:Organization
Organization Name:REVIVE RX LLC
Other - Org Name:REVIVE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-689-2271
Mailing Address - Street 1:3831 GOLF DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-5218
Mailing Address - Country:US
Mailing Address - Phone:888-689-2271
Mailing Address - Fax:888-689-1620
Practice Address - Street 1:3831 GOLF DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-5218
Practice Address - Country:US
Practice Address - Phone:888-689-2271
Practice Address - Fax:888-689-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309843336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy