NPIMap

Organization Active NPI

One Source Pharmacy, LLC

  • Community/Retail Pharmacy
  • Orlando, FL
National Provider Identifier
1336326784
Registry record updated Jun 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH25399 Issued in FL
Legal business name
ONE SOURCE PHARMACY, LLC
Practice address
6404 Old Winter Garden Rd
Ste 100
Orlando, FL 32835
Phone
(877) 490-8987
Fax
(877) 490-1060
NPI assigned
Jan 29, 2008
Organization subpart
Yes
Parent organization
ONE SOURCE PHARMACY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2011

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

Authorized official

Name
Mr. Indrajit Vyas
Title
Owner/ MGR
Phone
(877) 490-8987

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PH25399 FL Primary
Mail Order Pharmacy 3336M0002X PENDING FL

Addresses

Primary practice location

6404 Old Winter Garden Rd
Ste 100
Orlando, FL 32835

Mailing address

6404 Old Winter Garden Rd
Suite 250
Orlando, FL 32835
Phone (877) 490-8987

Other identifiers 1

IdentifierTypeStateIssuer
003464100MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
One Source Pharmacy LLC2 organizations share this tax ID, including this one
Part of
One Source Pharmacy LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6404 Old Winter Garden Rd
Ste 100
Orlando, FL 32835
Phone (877) 490-8987

6404 Old Winter Garden Rd
Ste 250
Orlando, FL 32835

NPI Registry JSON

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

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309305600000",
    "number": "1336326784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 OLD WINTER GARDEN RD",
            "address_2": "SUITE 250",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32835",
            "telephone_number": "877-490-8987",
            "fax_number": "877-490-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6404 OLD WINTER GARDEN RD",
            "address_2": "STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32835",
            "telephone_number": "877-490-8987",
            "fax_number": "877-490-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE SOURCE PHARMACY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ONE SOURCE PHARMACY, LLC",
        "enumeration_date": "2008-01-29",
        "last_updated": "2011-06-29",
        "status": "A",
        "authorized_official_last_name": "VYAS",
        "authorized_official_first_name": "INDRAJIT",
        "authorized_official_title_or_position": "OWNER/ MGR",
        "authorized_official_telephone_number": "877-490-8987",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25399",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PENDING",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003464100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; 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.