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:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-7377
Mailing Address - Street 1:515 SW 17TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3878
Mailing Address - Country:US
Mailing Address - Phone:305-854-7377
Mailing Address - Fax:305-854-7327
Practice Address - Street 1:515 SW 17TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3878
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:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH236653336L0003X
FLPH 236663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy