Provider Demographics
NPI:1093296774
Name:ONCOLOGY HEMATOLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY CONSULTANTS, PA
Other - Org Name:THE CENTER PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-759-7000
Mailing Address - Street 1:7415 LAS COLINAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7569
Mailing Address - Country:US
Mailing Address - Phone:214-379-2780
Mailing Address - Fax:214-379-2761
Practice Address - Street 1:7415 LAS COLINAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7569
Practice Address - Country:US
Practice Address - Phone:214-379-2780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311083336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
34094OtherPHARMACY LICENSE
TXFT1150185OtherDEA
34094OtherPHARMACY LICENSE
1629021159OtherNPI