One Source Pharmacy and Medical Supplies LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29690 Issued in TX

Legal business name

ONE SOURCE PHARMACY AND MEDICAL SUPPLIES LLC

Practice address

15733 San Pedro Ave
San Antonio, TX 78232-3726

Phone

(210) 493-8378

Fax

(210) 408-0722

NPI assigned

Dec 11, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jon Jimenez

Title

Ceo

Phone

(210) 493-8378

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• One Source Pharmacy and Medical Supplies Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Vejil, MPH

  • Health Educator
  • San Antonio, TX
  • NPI 1174912190
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435017600000",
    "number": "1174921803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15733 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782323726",
            "telephone_number": "210-493-8378",
            "fax_number": "210-408-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15733 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782323726",
            "telephone_number": "210-493-8378",
            "fax_number": "210-408-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE SOURCE PHARMACY AND MEDICAL SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2015-06-23",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-493-8378"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "29690",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149294",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "One Source Pharmacy and Medical Supplies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.