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General NPI Number Information
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NPI Number | 1184809592
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Entity Type | Organization
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Legal Business Name | PARKSIDE OASIS INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 3750 S UNIVERSITY DR SUITE 100
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City | FORT WORTH
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State | TX
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Zip | 76109-3720
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Country | US
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Telephone | 817-546-3513
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Fax | 817-546-3516
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Provider Business Mailing Address
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Address Line | 6306 PARKSIDE DR
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City | ARLINGTON
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State | TX
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Zip | 76001-8432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SALAKO
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Credential |
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Telephone | 817-874-1733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 25846
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License Number State | TX
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