Provider Demographics
NPI:1700824166
Name:RLS SUPERMARKETS LLC
Entity Type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:MINYARD PHARMACY #97
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-754-4436
Mailing Address - Street 1:10203 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4407
Mailing Address - Country:US
Mailing Address - Phone:214-221-5007
Mailing Address - Fax:214-221-5082
Practice Address - Street 1:10203 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4407
Practice Address - Country:US
Practice Address - Phone:214-221-5007
Practice Address - Fax:214-221-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298713336C0003X
332B00000X
TX213673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150201OtherPK
TX470478Medicaid
2098016OtherPK