1134175581 NPI number — GEISINGER PHARMACY LLC

Table of content: (NPI 1134175581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134175581 NPI number — GEISINGER PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEISINGER PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134175581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE # MC24-01
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-214-8503
Provider Business Mailing Address Fax Number:
570-271-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 WOODBINE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17821-8020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-214-8503
Provider Business Practice Location Address Fax Number:
570-271-5843
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP ENTERPRISE PHARMACY
Authorized Official Telephone Number:
570-271-6192

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  PP414060L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1507155 . This is a "GATEWAY PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 243353 . This is a "HIGHMARK BS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007535151387 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39JI10 . This is a "KEYSTONE HEALTH CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: GE205242 . This is a "GEISINGER HEALTH PLAN HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 132447 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 09HI10 . This is a "CAPITAL BLUE CROSS PROVID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000038000024 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1038440050013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181925 . This is a "BCNEPA ACCESS CARE PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 362013 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 95862 . This is a "HEALTH AMERICA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 996012 . This is a "BC NEPA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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