Provider Demographics
NPI:1912145582
Name:MED-SOURCE PHARMACY SERVICES CORP
Entity Type:Organization
Organization Name:MED-SOURCE PHARMACY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,ARNP
Authorized Official - Phone:305-854-7377
Mailing Address - Street 1:2223 SW 13TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3920
Mailing Address - Country:US
Mailing Address - Phone:305-854-7377
Mailing Address - Fax:305-854-7327
Practice Address - Street 1:2223 SW 13TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3920
Practice Address - Country:US
Practice Address - Phone:305-854-7377
Practice Address - Fax:305-854-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 236663336C0003X
FLPH236653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy