1548293871 NPI number — WEIS MARKETS INC

Table of content: (NPI 1548293871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548293871 NPI number — WEIS MARKETS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEIS MARKETS INC
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:
1548293871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S 2ND ST
Provider Second Line Business Mailing Address:
PO BOX 471
Provider Business Mailing Address City Name:
SUNBURY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17801-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-286-3623
Provider Business Mailing Address Fax Number:
570-988-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 PHOENIX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURYEA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-451-6390
Provider Business Practice Location Address Fax Number:
570-451-6392
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALTESE
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT PHARMACY
Authorized Official Telephone Number:
570-863-2809

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP415558L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3976517 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1770634 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007742100085 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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