Provider Demographics
NPI:1053357830
Name:RLS SUPERMARKETS LLC
Entity type:Organization
Organization Name:RLS SUPERMARKETS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3300 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3904
Mailing Address - Country:US
Mailing Address - Phone:817-540-3131
Mailing Address - Fax:817-685-8905
Practice Address - Street 1:3300 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3904
Practice Address - Country:US
Practice Address - Phone:817-540-3131
Practice Address - Fax:817-685-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299133336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150373OtherPK
TXP00229903Medicare PIN
TX0879960084Medicare NSC
4560959OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TXPHC014Medicare PIN