Provider Demographics
NPI:1508922873
Name:PARKSIDE OASIS INC
Entity Type:Organization
Organization Name:PARKSIDE OASIS INC
Other - Org Name:GENPHARM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIASE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RPH
Authorized Official - Phone:972-572-9006
Mailing Address - Street 1:3920 W WHEATLAND RD
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3401
Mailing Address - Country:US
Mailing Address - Phone:972-572-9006
Mailing Address - Fax:972-572-9016
Practice Address - Street 1:3920 W WHEATLAND RD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3401
Practice Address - Country:US
Practice Address - Phone:972-572-9006
Practice Address - Fax:972-572-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX296433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095878OtherPK
TX145449Medicaid
2095878OtherPK