Provider Demographics
NPI:1972016541
Name:ONESOURCE SPECIALTY MEDICINE LLC
Entity Type:Organization
Organization Name:ONESOURCE SPECIALTY MEDICINE LLC
Other - Org Name:ONESOURCE SPECIALTY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:469-547-1441
Mailing Address - Street 1:PO BOX 832042
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-2042
Mailing Address - Country:US
Mailing Address - Phone:469-547-1441
Mailing Address - Fax:877-848-1331
Practice Address - Street 1:8989 FOREST LN STE 138
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4137
Practice Address - Country:US
Practice Address - Phone:469-547-1441
Practice Address - Fax:877-848-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149830Medicaid