Provider Demographics
NPI:1174217244
Name:JENTRIFY RX, LLC
Entity type:Organization
Organization Name:JENTRIFY RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENTRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-416-2222
Mailing Address - Street 1:2637 IRA E WOODS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9012
Mailing Address - Country:US
Mailing Address - Phone:817-416-2222
Mailing Address - Fax:817-416-2223
Practice Address - Street 1:2637 IRA E WOODS AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9012
Practice Address - Country:US
Practice Address - Phone:817-416-2222
Practice Address - Fax:817-416-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy