Organization
MEDFRONT LLC
Active
Other names
MedFont Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OLAMIDE MAKINDE PHARM.D (OWNER/MGR/PIC)
(972) 709-2190
Entity
Organization
Contact information
Practice address
4041 W WHEATLAND RD STE 204, DALLAS, TX 75237-4061
(972) 709-2190
(972) 709-0190
Mailing address
4041 W WHEATLAND RD, SUITE 204, DALLAS, TX 75237-4063
(972) 709-2190
(972) 709-0190
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27977
TX
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135058
PK
—
05
—
340061601
—
TX
05
—
340061602
—
TX
05
—
340061603
—
TX
Enumeration date
12/18/2011
Last updated
07/19/2018
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