Provider Demographics
NPI:1821073073
Name:RMC MEDICAL PLAZA PHARMACY
Entity Type:Organization
Organization Name:RMC MEDICAL PLAZA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-498-4740
Mailing Address - Street 1:403 W CAMPBELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3465
Mailing Address - Country:US
Mailing Address - Phone:972-498-4740
Mailing Address - Fax:972-498-7644
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-498-4740
Practice Address - Fax:972-498-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15715333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15715OtherTEXAS PHARMACY LICENSE
TX144210Medicaid
4593225OtherNABP
TXBR3908324OtherDEA NUMBER