Provider Demographics
NPI:1780327122
Name:REJUVENATION PHARMACY INCORPORATED LLC
Entity type:Organization
Organization Name:REJUVENATION PHARMACY INCORPORATED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZARYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-844-8626
Mailing Address - Street 1:771 E SOUTHLAKE BLVD STE 223
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7065
Mailing Address - Country:US
Mailing Address - Phone:888-799-3879
Mailing Address - Fax:281-335-6645
Practice Address - Street 1:1550 NORWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3653
Practice Address - Country:US
Practice Address - Phone:888-799-3879
Practice Address - Fax:281-335-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy