Source One Pharmacy Services LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

SOURCE ONE PHARMACY SERVICES LLC

Practice address

1140 McDermott Dr Ste 104
Suite 104
West Chester, PA 19380-4043

Phone

(610) 696-3100

Fax

(610) 696-7100

NPI assigned

Dec 26, 2007

Organization subpart

No

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

Authorized official

Name

Constantine Nicholas Pippis, RPH

Title

Owner/Pharmacist

Phone

(610) 696-3100

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1376727495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 MCDERMOTT DR STE 104",
            "address_2": "SUITE 104",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193804043",
            "telephone_number": "610-696-3100",
            "fax_number": "610-696-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 MCDERMOTT DR STE 104",
            "address_2": "SUITE 104",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193804043",
            "telephone_number": "610-696-3100",
            "fax_number": "610-696-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE ONE PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "PIPPIS",
        "authorized_official_first_name": "CONSTANTINE",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "610-696-3100",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04172987",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376727495",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2082394",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0187470",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021341960002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "535302500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anitha Somasundaram, MD
• Joseph Song, DPT
• Michael M Soojian, MD
• Andrew Keith Sorber, PA-C
• John R Sorge Jr., DDS
• Southeastern PA Autism Resource Center
• Kevin Sowti, MD
• Gabrielle Spangler, OTD, OTR/L
• Samantha Spatocco
• Patrick Speakman, RPH

• Long Term Care Pharmacy in West Chester, PA
• Providers in West Chester, PA by specialty
• Long Term Care Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; 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.