Provider Demographics
NPI:1770010068
Name:ONESOURCE COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:ONESOURCE COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SESYLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:831-345-6404
Mailing Address - Street 1:104 WHISPERING PINES DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4799
Mailing Address - Country:US
Mailing Address - Phone:831-535-6864
Mailing Address - Fax:
Practice Address - Street 1:104 WHISPERING PINES DR STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066
Practice Address - Country:US
Practice Address - Phone:831-535-6864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 552943336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy