Provider Demographics
NPI:1487324273
Name:REVELES CLINICAL SERVICES
Entity type:Organization
Organization Name:REVELES CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RKES
Authorized Official - Middle Name:D
Authorized Official - Last Name:STARLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:817-846-6499
Mailing Address - Street 1:580 COMMERCE ST STE 150B
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9214
Mailing Address - Country:US
Mailing Address - Phone:817-482-9336
Mailing Address - Fax:817-476-8559
Practice Address - Street 1:580 COMMERCE ST STE 150B
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9214
Practice Address - Country:US
Practice Address - Phone:817-482-9336
Practice Address - Fax:817-476-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy