Provider Demographics
NPI:1407951288
Name:OAKDELL COMPOUNDING PHARMACY, LLC
Entity type:Organization
Organization Name:OAKDELL COMPOUNDING PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:STE 168
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-614-6200
Mailing Address - Fax:210-614-3848
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:STE 168
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-614-6200
Practice Address - Fax:210-616-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0004X
TX112473336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094659202Medicaid
2100731OtherPK
TX015835401Medicaid
TX147033Medicaid
TX094659201Medicaid
TX094659202Medicaid
4587765OtherOTHER ID NUMBER
TX094659201Medicaid