Provider Demographics
NPI:1013963404
Name:ONCOLOGY ALLIANCE
Entity Type:Organization
Organization Name:ONCOLOGY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHARM
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-906-4400
Mailing Address - Street 1:1055 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1055 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3436
Practice Address - Country:US
Practice Address - Phone:414-479-8450
Practice Address - Fax:414-479-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21799020332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32836000Medicaid
5129588OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5129588OtherOTHER ID NUMBER
5129588OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI0946910004Medicare NSC