Basic Information
| Provider Information | |||||||||
| NPI: | 1356064513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY PHARMACY SERVICE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731145 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753731145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9750 HILLWOOD PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761771507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176975640 | ||||||||
| FaxNumber: | 6825938125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIVONA | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | KEVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9729978103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.