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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1982389748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFRONT LLC

Provider Business Mailing Address
First Line	:	4041 W WHEATLAND RD STE 204
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-4061
Country	:	US
Telephone Number	:
Fax Number	:

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	:

Authorized Official
Title or Position	:	MANAGER
Name	:	OLAMIDE T MAKINDE
Credential	:
Telephone Number	:	972-709-2190

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “MEDFRONT LLC ” Practice Location

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