Organization
PHARMA SOURCE RX INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA CANTU (OFFICER)
(281) 762-2020
Entity
Organization
Contact information
Practice address
19855 SOUTHWEST FWY., STE. 220, SUGAR LAND, TX 77479
(281) 762-2020
(832) 363-1014
Mailing address
19855 SOUTHWEST FWY., STE. 220, SUGAR LAND, TX 77479
(281) 762-2020
(832) 363-1014
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150346
—
TX
01
—
32071001211
TIN
TX
Enumeration date
10/08/2020
Last updated
02/02/2022
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