Provider Demographics
NPI:1437197894
Name:RLS SUPERMARKETS LLC
Entity Type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:MINYARD PHARMACY #32
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-227-1222
Mailing Address - Street 1:6464 E MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2406
Mailing Address - Country:US
Mailing Address - Phone:214-827-4230
Mailing Address - Fax:214-823-6294
Practice Address - Street 1:6464 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2406
Practice Address - Country:US
Practice Address - Phone:214-827-4230
Practice Address - Fax:214-823-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX298173336C0003X
TX148433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470468Medicaid
2150141OtherPK
TX463372Medicaid