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Organization
SOURCE ONE PHARMACY SERVICES LLC
Active
Organization
SOURCE ONE PHARMACY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANTINE NICHOLAS PIPPIS RPH (OWNER/PHARMACIST)
(610) 696-3100
Entity
Organization
Contact information
Practice address
1140 MCDERMOTT DR STE 104, SUITE 104, WEST CHESTER, PA 19380-4043
(610) 696-3100
(610) 696-7100
Mailing address
1140 MCDERMOTT DR STE 104, SUITE 104, WEST CHESTER, PA 19380-4043
(610) 696-3100
(610) 696-7100
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187470
—
NJ
05
—
04172987
—
NY
05
—
1021341960002
—
PA
05
—
1376727495
—
DE
01
—
2082394
PK
—
05
—
535302500
—
MD
Enumeration date
12/26/2007
Last updated
10/02/2019
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