Basic Information
| Provider Information | |||||||||
| NPI: | 1215973797 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ONCOLOGY PHARMACY SERVICE, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | TEXAS ONCOLOGY PHARMACY HARLINGEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731145 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753731145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978103 | ||||||||
| FaxNumber: | 4694672535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 PEASE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563646735 | ||||||||
| FaxNumber: | 9563646786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 10/10/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SIMS | ||||||||
| AuthorizedOfficialFirstName: | J. | ||||||||
| AuthorizedOfficialMiddleName: | ERNEST | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9724902912 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 22498 | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | 333600000X | 22498 | TX | N | Suppliers | Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 166032601 | 05 | TX | MEDICAID | 4528747 | 01 | TX | NCPDP | OTHER | 22498 | 01 | TX | CLASS A LICENSE | OTHER | 320137 | 01 | TX | TX VENDOR DRUG | OTHER |