Provider Demographics
NPI:1265147581
Name:FACTOR ONE SOURCE PHARMACY LLC
Entity type:Organization
Organization Name:FACTOR ONE SOURCE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAYNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-828-3940
Mailing Address - Street 1:PO BOX 2578
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07096-2578
Mailing Address - Country:US
Mailing Address - Phone:877-828-3970
Mailing Address - Fax:877-828-3941
Practice Address - Street 1:217 GLENN ST STE 300
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2590
Practice Address - Country:US
Practice Address - Phone:877-828-3940
Practice Address - Fax:877-828-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy