Provider Demographics
NPI:1114208683
Name:ONCOLOGY PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:ONCOLOGY PHARMACY SERVICES, INC.
Other - Org Name:TEXAS ONCOLOGY PHARMACY SERVICES - GRAPEVINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-997-8000
Mailing Address - Street 1:PO BOX 731145
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1145
Mailing Address - Country:US
Mailing Address - Phone:972-997-8103
Mailing Address - Fax:469-467-2535
Practice Address - Street 1:1631 LANCASTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3585
Practice Address - Country:US
Practice Address - Phone:817-310-7027
Practice Address - Fax:817-310-7088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCOLOGY PHARMACY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-29
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275233336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX466808OtherDRUG VENDOR PROGRAM
TX466808OtherDRUG VENDOR PROGRAM