Provider Demographics
NPI:1508346297
Name:GREEN OAKS PHARMA INC.
Entity Type:Organization
Organization Name:GREEN OAKS PHARMA INC.
Other - Org Name:DFW WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAWANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-459-8400
Mailing Address - Street 1:711 E LAMAR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3854
Mailing Address - Country:US
Mailing Address - Phone:817-459-8400
Mailing Address - Fax:817-459-8402
Practice Address - Street 1:711 E LAMAR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3854
Practice Address - Country:US
Practice Address - Phone:817-459-8400
Practice Address - Fax:817-459-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312023336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146411Medicaid