Provider Demographics
NPI:1447555453
Name:DIRECT PHARMACY SOURCE, INC
Entity type:Organization
Organization Name:DIRECT PHARMACY SOURCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-997-4276
Mailing Address - Street 1:3540 NW 56TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2260
Mailing Address - Country:US
Mailing Address - Phone:877-367-3479
Mailing Address - Fax:833-347-9329
Practice Address - Street 1:3540 NW 56TH ST STE 204
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2260
Practice Address - Country:US
Practice Address - Phone:877-367-3479
Practice Address - Fax:833-347-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy