Organization
REVCO HEALTHCARE PHARMACY
Active
Other names
Revco Healthcare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GODWIN EWELIKE (PHARMACIST-IN-CHARGE)
(817) 307-3056
Entity
Organization
Contact information
Practice address
2505 E ARKANSAS LN STE 133, ARLINGTON, TX 76010-8700
(817) 303-5100
(817) 303-7910
Mailing address
2505 E ARKANSAS LN, SUITE 133, ARLINGTON, TX 76010-0212
(817) 303-5100
(817) 303-7910
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27942
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5905546
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/30/2012
Last updated
03/30/2012
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