MEDICARE: OVERFLOW PLUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	27042	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2126432	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013081546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERFLOW PLUS LLC

Provider Business Mailing Address
First Line	:	4373 S HAMPTON RD
Second Line	:	STE 1
City	:	DALLAS
State	:	TX
Zip	:	75232-1058
Country	:	US
Telephone Number	:	972-620-2121
Fax Number	:	972-484-2603

Provider Business Practice Location Address
First Line	:	4373 S HAMPTON RD STE 1
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1058
Country	:	US
Telephone Number	:	972-620-2121
Fax Number	:	972-484-2603

Authorized Official
Title or Position	:	CEO
Name	:	NDUFOLA KIGHAM
Credential	:
Telephone Number	:	972-620-2121

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/24/2014

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Directions to “OVERFLOW PLUS LLC ” Practice Location

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