Provider Demographics
NPI:1679850101
Name:YOUR RX PHARMACY INC
Entity Type:Organization
Organization Name:YOUR RX PHARMACY INC
Other - Org Name:YOUR RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAFUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-457-5571
Mailing Address - Street 1:2637 IRA E WOODS AVE
Mailing Address - Street 2:#200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9010
Mailing Address - Country:US
Mailing Address - Phone:817-416-2222
Mailing Address - Fax:817-416-2223
Practice Address - Street 1:2637 IRA E WOODS AVE
Practice Address - Street 2:#200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9010
Practice Address - Country:US
Practice Address - Phone:817-416-2222
Practice Address - Fax:817-416-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27755333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679850101OtherNPI
TXD0185339OtherDPS-TEXAS STATE CONTROLLED SUBSTANCE LIC #
TX27755OtherRETAIL PHARMACY PERMIT
TX5904431OtherNCPDP/NABP
TX146481Medicaid
TX146481Medicaid