Organization
ONE SOURCE PHARMACY AND MEDICAL SUPPLIES LLC
Active
Other names
One Source Pharmacy and Medical Supplies
Organization subpart
No
Provider details
NPI number
Authorized official
JON JIMENEZ (CEO)
(210) 493-8378
Entity
Organization
Contact information
Practice address
15733 SAN PEDRO AVE, SAN ANTONIO, TX 78232-3726
(210) 493-8378
(210) 408-0722
Mailing address
15733 SAN PEDRO AVE, SAN ANTONIO, TX 78232-3726
(210) 493-8378
(210) 408-0722
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29690
TX
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149294
PK
—
Enumeration date
12/11/2014
Last updated
06/23/2015
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