Provider Demographics
NPI:1437600392
Name:REVIVE RX LLC
Entity type:Organization
Organization Name:REVIVE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-689-2271
Mailing Address - Street 1:3831 GOLF DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-5218
Mailing Address - Country:US
Mailing Address - Phone:888-689-2271
Mailing Address - Fax:888-689-1620
Practice Address - Street 1:3831 GOLF DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-5218
Practice Address - Country:US
Practice Address - Phone:888-689-2271
Practice Address - Fax:888-689-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOSP.0006854333600000X
FL303633336C0003X
AZY0069743336C0004X
MO20160428263336M0002X
TX309843336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168005OtherPK