Provider Demographics
NPI:1215188594
Name:WEIS MARKETS INC
Entity Type:Organization
Organization Name:WEIS MARKETS INC
Other - Org Name:WEIS PHARMACY #74
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHCY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-863-2812
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-0471
Mailing Address - Country:US
Mailing Address - Phone:570-286-3623
Mailing Address - Fax:570-988-3774
Practice Address - Street 1:2525 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9254
Practice Address - Country:US
Practice Address - Phone:570-674-1120
Practice Address - Fax:570-674-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3991189OtherNCPDP
PA1007742100286Medicaid
PA1007742100286Medicaid