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General NPI Number Information
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NPI Number | 1932478112
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Entity Type | Organization
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Legal Business Name | MEDFRONT LLC
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Dates
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Enumeration Date | 12/18/2011
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 4041 W WHEATLAND RD STE 204
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City | DALLAS
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State | TX
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Zip | 75237-4061
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Country | US
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Telephone | 972-709-2190
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Fax | 972-709-0190
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Provider Business Mailing Address
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Address Line | 4041 W WHEATLAND RD SUITE 204
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City | DALLAS
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State | TX
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Zip | 75237-4063
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Country | US
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Telephone | 972-709-2190
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Fax | 972-709-0190
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Authorized Official
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Title or Position | OWNER/MGR/PIC
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Name | OLAMIDE MAKINDE
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Credential | PHARM.D
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Telephone | 972-709-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 333600000X
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Taxonomy Name | 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 | 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 #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27977
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License Number State | TX
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