Provider Demographics
NPI:1306587621
Name:REUSSI HEALTHCARE PLLC
Entity type:Organization
Organization Name:REUSSI HEALTHCARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMODIMU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:832-755-3078
Mailing Address - Street 1:8055 WINDROSE AVE APT 3121
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0268
Mailing Address - Country:US
Mailing Address - Phone:832-755-3078
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 311
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5468
Practice Address - Country:US
Practice Address - Phone:832-755-3078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No333600000XSuppliersPharmacy