Provider Demographics
NPI:1912059262
Name:OAKDELL PHARMACY LLC
Entity Type:Organization
Organization Name:OAKDELL PHARMACY LLC
Other - Org Name:OAKDELL PHARMACY AT THE QUARRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-1005
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:STE 176
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-822-6330
Mailing Address - Fax:210-614-3848
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2060
Practice Address - Country:US
Practice Address - Phone:210-822-6330
Practice Address - Fax:210-614-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX252473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099933OtherPK
TX145762Medicaid