MEDICARE: HEALTH SOURCE PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	28411	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2138616	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417201690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH SOURCE PHARMACY INC

Provider Business Mailing Address
First Line	:	809 GALLAGHER DR STE J1
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3111
Country	:	US
Telephone Number	:	903-893-1700
Fax Number	:	903-893-1702

Provider Business Practice Location Address
First Line	:	809 GALLAGHER DR STE J1
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3111
Country	:	US
Telephone Number	:	903-893-1700
Fax Number	:	903-893-1702

Authorized Official
Title or Position	:	OFFICER/PIC
Name	:	DINESH SRIPERAMBUDUR
Credential	:
Telephone Number	:	903-893-1700

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	04/06/2025

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Directions to “HEALTH SOURCE PHARMACY INC ” Practice Location

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