Provider Demographics
NPI:1356492177
Name:WELLSPAN PHARMACY, INC
Entity Type:Organization
Organization Name:WELLSPAN PHARMACY, INC
Other - Org Name:WELLSPAN PHARMACY - BIGLERVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - WELLSPAN PHARMACY, INC.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-5895
Mailing Address - Street 1:3460 BIGLERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307
Mailing Address - Country:US
Mailing Address - Phone:717-677-6600
Mailing Address - Fax:717-677-9262
Practice Address - Street 1:3460 BIGLERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307
Practice Address - Country:US
Practice Address - Phone:717-677-6600
Practice Address - Fax:717-677-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410599L332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007431520003Medicaid
PA0325770006Medicare NSC