Provider Demographics
NPI:1790017697
Name:ONCOLOGY CENTER OF SOUTHWEST P A
Entity Type:Organization
Organization Name:ONCOLOGY CENTER OF SOUTHWEST P A
Other - Org Name:DEXTER SPECIALITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-758-2664
Mailing Address - Street 1:4712 DEXTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5290
Mailing Address - Country:US
Mailing Address - Phone:972-758-2664
Mailing Address - Fax:972-758-2660
Practice Address - Street 1:4712 DEXTER DR STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5290
Practice Address - Country:US
Practice Address - Phone:972-758-2664
Practice Address - Fax:972-758-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0004X, 3336S0011X
TX266963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554855OtherNCPDP PROVIDER IDENTIFICATION NUMBER