Organization
ONE SOURCE PHARMACY SERVICES INC.
Active
Other names
Fairview Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PRITAL SUDHIR SHUKLA (PRESIDENT)
(212) 567-3384
Entity
Organization
Contact information
Practice address
4480 BROADWAY, NEW YORK, NY 10040-2606
(212) 567-3384
(212) 567-9643
Mailing address
4480 BROADWAY, NEW YORK, NY 10040-2606
(212) 567-3384
(212) 567-9643
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
024844
NY
3336C0003X
Community/Retail Pharmacy
Primary
024844
NY
3336C0004X
Compounding Pharmacy
024844
NY
3336H0001X
Home Infusion Therapy Pharmacy
024844
NY
3336S0011X
Specialty Pharmacy
024844
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02105493
—
NY
Enumeration date
09/26/2006
Last updated
12/01/2025
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