Healthcare Provider Details

I. General information

NPI: 1114208683
Provider Name (Legal Business Name): ONCOLOGY PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 LANCASTER DR SUITE 150
GRAPEVINE TX
76051-3585
US

IV. Provider business mailing address

PO BOX 731145
DALLAS TX
75373-1145
US

V. Phone/Fax

Practice location:
  • Phone: 817-310-7027
  • Fax: 817-310-7088
Mailing address:
  • Phone: 972-997-8103
  • Fax: 469-467-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number27523
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIM SHADDOX
Title or Position: DIRECTOR
Credential:
Phone: 972-997-8000