Provider Demographics
NPI:1376052159
Name:MCKINNEY ONCOLOGY PHARMACY
Entity Type:Organization
Organization Name:MCKINNEY ONCOLOGY PHARMACY
Other - Org Name:MCKINNEY ONCOLOGY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-714-0565
Mailing Address - Street 1:4201 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 320 A
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1766
Mailing Address - Country:US
Mailing Address - Phone:469-714-0565
Mailing Address - Fax:469-617-7606
Practice Address - Street 1:4201 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 320 A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1766
Practice Address - Country:US
Practice Address - Phone:469-714-0565
Practice Address - Fax:469-617-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX315933336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171397OtherPK
2171397OtherPK