1689754079 NPI number — WELLSPAN PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689754079 NPI number — WELLSPAN PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPAN PHARMACY 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:
1689754079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-0140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-6903
Provider Business Mailing Address Fax Number:
717-851-5407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 FAIRFIELD RD STE B
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17320-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-642-8812
Provider Business Practice Location Address Fax Number:
717-642-6691
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHARNETSKI
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR PHARMACY MANAGER
Authorized Official Telephone Number:
570-262-6663

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PP415301L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PP415301L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP415301L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PP415301L . This is a "PHARMACY LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007431520005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3973282 . This is a "NABP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com