Revco Healthcare Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27942 Issued in TX

Legal business name

REVCO HEALTHCARE PHARMACY

Practice address

2505 E Arkansas LN Ste 133
Arlington, TX 76010-8700

Phone

(817) 303-5100

Fax

(817) 303-7910

NPI assigned

Mar 30, 2012

Organization subpart

No

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

Authorized official

Name

Godwin Ewelike

Title

Pharmacist-in-Charge

Phone

(817) 307-3056

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Revco Healthcare Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1457627705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 E ARKANSAS LN",
            "address_2": "SUITE 133",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760100212",
            "telephone_number": "817-303-5100",
            "fax_number": "817-303-7910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 E ARKANSAS LN STE 133",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760108700",
            "telephone_number": "817-303-5100",
            "fax_number": "817-303-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVCO HEALTHCARE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "EWELIKE",
        "authorized_official_first_name": "GODWIN",
        "authorized_official_title_or_position": "PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "817-307-3056"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5905546",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revco Healthcare Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Arlington, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.