Healthcare Provider Details

I. General information

NPI: 1750482980
Provider Name (Legal Business Name): ONE SOURCE PHARMACY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 BROADWAY
NEW YORK NY
10040-2606
US

IV. Provider business mailing address

4480 BROADWAY
NEW YORK NY
10040-2606
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-3384
  • Fax: 212-567-9643
Mailing address:
  • Phone: 212-567-3384
  • Fax: 212-567-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number024844
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number024844
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number024844
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number024844
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number024844
License Number StateNY

VIII. Authorized Official

Name: PRITAL SUDHIR SHUKLA
Title or Position: PRESIDENT
Credential:
Phone: 212-567-3384