# SOURCE ONE PHARMACY SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376727495
- **Authorized official:** CONSTANTINE NICHOLAS PIPPIS RPH (OWNER/PHARMACIST)
- **Authorized official phone:** (610) 696-3100

## Contact information

- **Practice address:** 1140 MCDERMOTT DR STE 104, SUITE 104, WEST CHESTER, PA 19380-4043
- **Practice address phone:** (610) 696-3100
- **Practice address fax:** (610) 696-7100
- **Mailing address:** 1140 MCDERMOTT DR STE 104, SUITE 104, WEST CHESTER, PA 19380-4043
- **Mailing address phone:** (610) 696-3100
- **Mailing address fax:** (610) 696-7100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2007
- **Last updated:** 10/02/2019

## 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 |