Provider Demographics
NPI:1174656177
Name:G. SPEARING WEISS LLC
Entity Type:Organization
Organization Name:G. SPEARING WEISS LLC
Other - Org Name:BLAKESLEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-646-8040
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610
Mailing Address - Country:US
Mailing Address - Phone:570-646-8040
Mailing Address - Fax:570-643-9031
Practice Address - Street 1:393 RT 940
Practice Address - Street 2:SUITE 1
Practice Address - City:BLAKESLEE
Practice Address - State:PA
Practice Address - Zip Code:18610
Practice Address - Country:US
Practice Address - Phone:570-646-8040
Practice Address - Fax:570-643-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412175L333600000X
3336C0003X, 3336C0004X, 3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7575708Medicaid
2081195OtherPK
2081195OtherPK