Provider Demographics
NPI:1407808504
Name:RETAIL INVESTORS OF TEXAS, LTD.
Entity Type:Organization
Organization Name:RETAIL INVESTORS OF TEXAS, LTD.
Other - Org Name:MARKET BASKET PHARMACIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SKYLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-749-6405
Mailing Address - Street 1:PO BOX 1717
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:409-749-6505
Practice Address - Street 1:655 LAVACA ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-3811
Practice Address - Country:US
Practice Address - Phone:409-835-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143493Medicaid
TX58564OtherCIDC #
TXDMEH26222Medicare ID - Type UnspecifiedMEDICARE PROVIDER #