Provider Demographics
NPI:1922037993
Name:RLS SUPERMARKETS LLC
Entity Type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:MINYARD PHARMACY #25
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 1:4836 W PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2330
Mailing Address - Country:US
Mailing Address - Phone:972-964-8287
Mailing Address - Fax:972-985-7807
Practice Address - Street 1:4836 W PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2330
Practice Address - Country:US
Practice Address - Phone:972-964-8287
Practice Address - Fax:972-985-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299283336C0003X
TX221353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150371OtherPK
TX463760Medicaid
TXP00229903Medicare PIN
4571445OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TXPHC014Medicare PIN