Provider Demographics
NPI:1477630333
Name:RLS SUPERMARKETS LLC
Entity Type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:MINYARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-277-3524
Mailing Address - Street 1:DEPT. D8020
Mailing Address - Street 2:PO BOX 650002
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0002
Mailing Address - Country:US
Mailing Address - Phone:325-277-3524
Mailing Address - Fax:
Practice Address - Street 1:2200 W SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-5056
Practice Address - Country:US
Practice Address - Phone:972-790-3753
Practice Address - Fax:972-790-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470467Medicaid
2130859OtherPK