MEDICARE: ONCOLOGY HEMATOLOGY CONSULTANTS, PA

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	31108	TX
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34094	OTHER		PHARMACY LICENSE

General Provider Information

NPI Number	:	1093296774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONCOLOGY HEMATOLOGY CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	7415 LAS COLINAS BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7569
Country	:	US
Telephone Number	:	214-379-2780
Fax Number	:	214-379-2761

Provider Business Practice Location Address
First Line	:	7415 LAS COLINAS BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7569
Country	:	US
Telephone Number	:	214-379-2780
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BARRY RUSSO
Credential	:
Telephone Number	:	817-759-7000

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	06/07/2022

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