Organization
62 ROSES WELLNESS, LLC
Active
Organization
62 ROSES WELLNESS, LLC
Active
Other names
24 Wellness Rx
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BAXTER (CEO)
(903) 530-5987
Entity
Organization
Contact information
Practice address
3320 TROUP HWY STE 140, TYLER, TX 75701-8358
(682) 207-1232
(817) 900-0649
Mailing address
1620 W NORTHWEST HWY STE 100, GRAPEVINE, TX 76051-3219
(817) 572-0009
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33114
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
06/09/2020
Last updated
06/09/2020
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