Provider Demographics
NPI:1417201690
Name:HEALTH SOURCE PHARMACY INC
Entity Type:Organization
Organization Name:HEALTH SOURCE PHARMACY INC
Other - Org Name:CARERX PHARMACY AT SHERMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIPERAMBUDUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-893-1700
Mailing Address - Street 1:1733 TEXOMA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2613
Mailing Address - Country:US
Mailing Address - Phone:903-893-1700
Mailing Address - Fax:903-893-1702
Practice Address - Street 1:1733 TEXOMA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2613
Practice Address - Country:US
Practice Address - Phone:903-893-1700
Practice Address - Fax:903-893-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138616OtherPK
TX146709Medicaid
TX6789110001Medicare NSC