Provider Demographics
NPI:1659780302
Name:AYDIL RX SERVICES, LLC
Entity Type:Organization
Organization Name:AYDIL RX SERVICES, LLC
Other - Org Name:MEDICINE SHOPPE #2015
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-839-0724
Mailing Address - Street 1:1440 GARDENIA ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4232
Mailing Address - Country:US
Mailing Address - Phone:972-839-0724
Mailing Address - Fax:
Practice Address - Street 1:3001 JOE RAMSEY BLVD E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7714
Practice Address - Country:US
Practice Address - Phone:903-455-7200
Practice Address - Fax:903-455-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294033336C0003X
3336C0004X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146060OtherPK