Provider Demographics
NPI:1528217106
Name:P & S REXALL PHARMACY,INC
Entity Type:Organization
Organization Name:P & S REXALL PHARMACY,INC
Other - Org Name:P & S PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-874-5121
Mailing Address - Street 1:829 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3048
Mailing Address - Country:US
Mailing Address - Phone:903-874-5121
Mailing Address - Fax:903-872-1925
Practice Address - Street 1:829 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3048
Practice Address - Country:US
Practice Address - Phone:903-874-5121
Practice Address - Fax:903-872-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy