62 Roses Wellness, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

62 ROSES WELLNESS, LLC

Doing business as

24 Wellness Rx

Practice address

3320 Troup Hwy Ste 140
Tyler, TX 75701-8358

Phone

(682) 207-1232

Fax

(817) 900-0649

NPI assigned

Jun 9, 2020

Last updated

Jun 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Baxter

Title

Ceo

Phone

(903) 530-5987

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• 24 Wellness Rx Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1144845827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W NORTHWEST HWY STE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513219",
            "telephone_number": "817-572-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 TROUP HWY STE 140",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018358",
            "telephone_number": "682-207-1232",
            "fax_number": "817-900-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "62 ROSES WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-530-5987"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "33114",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "24 Wellness Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.