Provider Demographics
NPI:1891122834
Name:ONE SOURCE RX, LLC
Entity Type:Organization
Organization Name:ONE SOURCE RX, LLC
Other - Org Name:ONE SOURCE RX, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PORTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-790-4774
Mailing Address - Street 1:PO BOX 531228
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35253-1228
Mailing Address - Country:US
Mailing Address - Phone:205-244-1444
Mailing Address - Fax:
Practice Address - Street 1:3008 CLAIRMONT AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1113
Practice Address - Country:US
Practice Address - Phone:205-244-1444
Practice Address - Fax:205-244-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-05
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1142193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142386OtherPK