Provider Demographics
NPI:1346288701
Name:RLS SUPERMARKETS LLC
Entity Type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:MINYARD PHARMACY #40
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-387-8977
Mailing Address - Street 1:7007 ARAPAHO RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4158
Mailing Address - Country:US
Mailing Address - Phone:972-387-8977
Mailing Address - Fax:972-387-9360
Practice Address - Street 1:7007 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4158
Practice Address - Country:US
Practice Address - Phone:972-387-8977
Practice Address - Fax:972-387-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX298723336C0003X
TX148513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150196OtherPK
TX470470Medicaid
0483390131Medicare NSC