Provider Demographics
NPI:1467156695
Name:REVITA RX PLLC
Entity Type:Organization
Organization Name:REVITA RX PLLC
Other - Org Name:CARENOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEBE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-408-7785
Mailing Address - Street 1:1933 E FRANKFORD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5394
Mailing Address - Country:US
Mailing Address - Phone:469-649-9442
Mailing Address - Fax:469-919-4772
Practice Address - Street 1:1933 E FRANKFORD RD STE 120
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5394
Practice Address - Country:US
Practice Address - Phone:972-333-2831
Practice Address - Fax:214-387-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy