Provider Demographics
NPI:1184654469
Name:GEISINGER PHARMACY, LLC
Entity Type:Organization
Organization Name:GEISINGER PHARMACY, LLC
Other - Org Name:GEISINGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP ENTERPRISE PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6192
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2575
Mailing Address - Country:US
Mailing Address - Phone:570-271-7965
Mailing Address - Fax:570-271-7370
Practice Address - Street 1:529 TERRY REILEY WAY
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1774
Practice Address - Country:US
Practice Address - Phone:570-624-4120
Practice Address - Fax:570-624-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4815173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007535151280Medicaid
2126060OtherPK
PA1007535151280Medicaid