Organization
PARKSIDE OASIS INC
Active
Other names
RAINBOW PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SALAKO (OWNER)
(817) 874-1733
Entity
Organization
Contact information
Practice address
3750 S UNIVERSITY DR, SUITE 100, FORT WORTH, TX 76109-3720
(817) 546-3513
(817) 546-3516
Mailing address
6306 PARKSIDE DR, ARLINGTON, TX 76001-8432
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25846
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4546947
OTHER ID NUMBER
—
Enumeration date
01/03/2008
Last updated
01/29/2008
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