| Renue RX #12 | |
|
150 N Coppell Rd Ste Pharmacy Coppell TX 75019-2293 | |
| (972) 371-0067 | |
| Not Available |
| Full Name | Renue RX #12 |
|---|---|
| Speciality | Pharmacy |
| Location | 150 N Coppell Rd Ste Pharmacy, Coppell, Texas |
| Authorized Official Name and Position | Raj Chhadua (MANAGING PARTNER) |
| Authorized Official Contact | 2144222598 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renue RX #12 Po Box 2735 Frisco TX 75034-0051 Ph: (214) 422-2598 | Renue RX #12 150 N Coppell Rd Ste Pharmacy Coppell TX 75019-2293 Ph: (972) 371-0067 |
| NPI Number | 1225708225 |
|---|---|
| Provider Enumeration Date | 09/20/2021 |
| Last Update Date | 08/14/2023 |
| Certification Date | 08/14/2023 |
| Medicare PECOS PAC ID | 7416343298 |
|---|---|
| Medicare Enrollment ID | O20220404001094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225708225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 3336C0003X | Pharmacy - Community/retail Pharmacy | () | Primary |
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