MEDICARE: PARKSIDE OASIS INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	29643	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2095878	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508922873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE OASIS INC

Provider Business Mailing Address
First Line	:	3920 W WHEATLAND RD
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75237-3401
Country	:	US
Telephone Number	:	972-572-9006
Fax Number	:	972-572-9016

Provider Business Practice Location Address
First Line	:	3920 W WHEATLAND RD
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75237-3401
Country	:	US
Telephone Number	:	972-572-9006
Fax Number	:	972-572-9016

Authorized Official
Title or Position	:	PHARMACIST, OWNER
Name	:	NICHOLAS ODIASE
Credential	:	BS, RPH
Telephone Number	:	972-572-9006

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	04/18/2017

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Directions to “PARKSIDE OASIS INC ” Practice Location

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