MEDICARE: ONE SOURCE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	RPT35003	FL

General Provider Information

NPI Number	:	1013287374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE SOURCE PHARMACY

Provider Business Mailing Address
First Line	:	6404 OLD WINTER GARDEN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1348
Country	:	US
Telephone Number	:	877-490-8987
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 OLD WINTER GARDEN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1348
Country	:	US
Telephone Number	:	877-490-8987
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY TECHNICIAN
Name	:	LINDA E GOLUBIC
Credential	:	CPHT
Telephone Number	:	877-490-8987

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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Directions to “ONE SOURCE PHARMACY ” Practice Location

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