Provider Demographics
NPI:1942813472
Name:MOUL, REXSTON CHAMREUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:REXSTON
Middle Name:CHAMREUN
Last Name:MOUL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COIT RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6171
Mailing Address - Country:US
Mailing Address - Phone:469-974-3661
Mailing Address - Fax:469-974-3663
Practice Address - Street 1:3826 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4136
Practice Address - Country:US
Practice Address - Phone:214-522-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist