Provider Demographics
NPI:1689779456
Name:P & S REXALL PHARMACY INC
Entity Type:Organization
Organization Name:P & S REXALL PHARMACY INC
Other - Org Name:P & S PHARMACY
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:903-874-5691
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:829 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3048
Practice Address - Country:US
Practice Address - Phone:903-874-5691
Practice Address - Fax:903-872-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 3336C0004X
TX100463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102884OtherPK
TX142376Medicaid
TX142376Medicaid