1720522246 NPI number — WEIS MARKETS, INC.

Table of content: (NPI 1720522246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720522246 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:
1720522246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2017
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:
P.O. 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:
4525 VALLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17025-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-732-4106
Provider Business Practice Location Address Fax Number:
717-732-4716
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SEIPP
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
VICE PRESIDENT, PHARMACY
Authorized Official Telephone Number:
570-863-2812

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP482705 , 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: 6004864 . This is a "NCPDP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007742100302 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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