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General NPI Number Information
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NPI Number | 1891122834
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Entity Type | Organization
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Legal Business Name | ONE SOURCE RX, LLC
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Dates
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Enumeration Date | 10/05/2013
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Last Update Date | 10/05/2013
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Provider Practice Location Address
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Address Line | 3008 CLAIRMONT AVE S STE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1113
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Country | US
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Telephone | 205-244-1444
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Fax | 205-244-1119
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Provider Business Mailing Address
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Address Line | PO BOX 531228
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City | BIRMINGHAM
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State | AL
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Zip | 35253-1228
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Country | US
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Telephone | 205-244-1444
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | PORTER MCCOLLISTER
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Credential |
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Telephone | 205-790-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 114219
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License Number State | AL
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