Healthcare Provider Details

I. General information

NPI: 1811523905
Provider Name (Legal Business Name): PHARMA SOURCE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19855 SOUTHWEST FWY STE 220
SUGAR LAND TX
77479-6536
US

IV. Provider business mailing address

301 S 9TH ST STE 109
RICHMOND TX
77469-3448
US

V. Phone/Fax

Practice location:
  • Phone: 281-762-2020
  • Fax: 832-363-1014
Mailing address:
  • Phone: 281-762-2020
  • Fax: 832-363-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURA L CANTU
Title or Position: MANAGING OFFICER/OWNER
Credential:
Phone: 281-762-2020