Provider Demographics
NPI:1427162411
Name:P & S REXALL PHARMACY INC
Entity type:Organization
Organization Name:P & S REXALL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-874-5121
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0957
Mailing Address - Country:US
Mailing Address - Phone:903-874-5121
Mailing Address - Fax:903-872-1925
Practice Address - Street 1:829 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3048
Practice Address - Country:US
Practice Address - Phone:903-874-5121
Practice Address - Fax:903-872-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX249203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148091Medicaid
2099188OtherPK