Provider Demographics
NPI:1366324022
Name:FOUR LEAF RX, LLC
Entity type:Organization
Organization Name:FOUR LEAF RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-473-5357
Mailing Address - Street 1:1309 W 15TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7244
Mailing Address - Country:US
Mailing Address - Phone:888-796-7286
Mailing Address - Fax:844-469-1073
Practice Address - Street 1:1309 W 15TH ST STE 320
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7244
Practice Address - Country:US
Practice Address - Phone:888-796-7286
Practice Address - Fax:844-469-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy