Provider Demographics
NPI:1013287374
Name:ONE SOURCE PHARMACY
Entity Type:Organization
Organization Name:ONE SOURCE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLUBIC
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:877-490-8987
Mailing Address - Street 1:6404 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1348
Mailing Address - Country:US
Mailing Address - Phone:877-490-8987
Mailing Address - Fax:
Practice Address - Street 1:6404 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1348
Practice Address - Country:US
Practice Address - Phone:877-490-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT35003302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization