Provider Demographics
NPI:1164296935
Name:FAMILIAR ONE SOURCE LLC
Entity Type:Organization
Organization Name:FAMILIAR ONE SOURCE LLC
Other - Org Name:DC ALL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-486-8487
Mailing Address - Street 1:11800 MAGNOLIA PKWY STE 123
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1799
Mailing Address - Country:US
Mailing Address - Phone:832-541-3152
Mailing Address - Fax:
Practice Address - Street 1:11800 MAGNOLIA PKWY STE 123
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1799
Practice Address - Country:US
Practice Address - Phone:346-486-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy