Provide RX of Grapevine

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

25809 Issued in TX

Legal business name

PROVIDE RX OF GRAPEVINE

Doing business as

PROVIDE RX OF GRAPEVINE

Practice address

771 E US Highway 80 Ste 210
Forney, TX 75126-8699

Phone

(817) 310-5554

Fax

(817) 310-0862

NPI assigned

Dec 14, 2007

Organization subpart

No

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

Authorized official

Name

Reef Gillum

Title

President

Phone

(817) 778-8777

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PROVIDE RX OF GRAPEVINE Doing business as

Locations

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1326221268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2176",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751262176",
            "telephone_number": "817-310-5554",
            "fax_number": "817-756-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 E US HIGHWAY 80 STE 210",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268699",
            "telephone_number": "817-310-5554",
            "fax_number": "817-310-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDE RX OF GRAPEVINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "REEF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-778-8777"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "25809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4546555",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDE RX OF GRAPEVINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Forney, TX
• Providers in Forney, TX by specialty
• Long Term Care Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.