| NPI | 1063736304 |
|---|---|
| Doing Business As | MEDSOURCE RX PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SAHILY PAOLINE PIC 888-702-2195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: UT 7609917-1703) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2013-10-11 |