MEDICARE: OAK CLIFF PHARMACY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	25321	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2099681	OTHER	PK

General Provider Information

NPI Number	:	1740354273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK CLIFF PHARMACY LLC

Provider Business Mailing Address
First Line	:	3436 S POLK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-3804
Country	:	US
Telephone Number	:	214-371-2815
Fax Number	:	214-371-0606

Provider Business Practice Location Address
First Line	:	3436 S POLK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-3804
Country	:	US
Telephone Number	:	214-371-2815
Fax Number	:	214-371-0606

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	RONALD BARRETT
Credential	:
Telephone Number	:	214-371-2815

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	04/05/2017

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Directions to “OAK CLIFF PHARMACY LLC ” Practice Location

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