Provider Demographics
NPI:1346727609
Name:MEDICINESPLUS INTEGRATIVE CARE LLC
Entity Type:Organization
Organization Name:MEDICINESPLUS INTEGRATIVE CARE LLC
Other - Org Name:IMEDSPLUS I-CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAZIM
Authorized Official - Middle Name:OLADOTUN
Authorized Official - Last Name:OYENUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-473-6867
Mailing Address - Street 1:2603 OAK LAWN AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2603 OAK LAWN AVE STE 101A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4059
Practice Address - Country:US
Practice Address - Phone:972-478-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32080333600000X
3336C0004X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEID