Organization · NPI-2
62 Roses Wellness, LLC
Pharmacy, Community/Retail Pharmacy · Tyler, TX
NPI number1144845827
StatusActive
Last updated in NPPESJun 9, 2020
Details
- NPI
- 1144845827
- Entity type
- Organization (NPI-2)
- Legal business name
- 62 Roses Wellness, LLC
- Organization subpart
- No
- Enumeration date
- Jun 9, 2020
- Certification date
- Jun 9, 2020
- Last updated
- Jun 9, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 333600000X | Pharmacy | – | – | |
| 3336C0004X | Pharmacy, Compounding Pharmacy | – | – |
Other names
- 24 Wellness Rx (Doing Business As)
Practice location
3320 Troup Hwy Ste 140Tyler, TX 75701-8358
Phone 682-207-1232 · Fax 817-900-0649
Mailing address
1620 W Northwest Hwy Ste 100Grapevine, TX 76051-3219
Phone 817-572-0009
Authorized official
Gary Baxter
Ceo
9035305987
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