Provider Demographics
NPI:1770703894
Name:OAK CLIFF PHARMACY LLC
Entity type:Organization
Organization Name:OAK CLIFF PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-371-2815
Mailing Address - Street 1:3434 S POLK ST STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3890
Mailing Address - Country:US
Mailing Address - Phone:214-371-2815
Mailing Address - Fax:214-281-8428
Practice Address - Street 1:3434 S POLK ST STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3890
Practice Address - Country:US
Practice Address - Phone:214-371-2815
Practice Address - Fax:214-281-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25321261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25321OtherSTATE LICENSE NUMBER
TX145733Medicaid
FO0087797OtherDEA NUMBER