MEDICARE: MEDFRONT 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	27977	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2135058	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932478112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFRONT LLC

Provider Business Mailing Address
First Line	:	4041 W WHEATLAND RD
Second Line	:	SUITE 204
City	:	DALLAS
State	:	TX
Zip	:	75237-4063
Country	:	US
Telephone Number	:	972-709-2190
Fax Number	:	972-709-0190

Provider Business Practice Location Address
First Line	:	4041 W WHEATLAND RD STE 204
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-4061
Country	:	US
Telephone Number	:	972-709-2190
Fax Number	:	972-709-0190

Authorized Official
Title or Position	:	OWNER/MGR/PIC
Name	:	OLAMIDE MAKINDE
Credential	:	PHARM.D
Telephone Number	:	972-709-2190

Provider Enumeration Date	:	12/18/2011
Last Update Date	:	07/19/2018

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Directions to “MEDFRONT LLC ” Practice Location

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