Provider Demographics
NPI:1396197760
Name:WEIS MARKETS, INC.
Entity Type:Organization
Organization Name:WEIS MARKETS, INC.
Other - Org Name:WEIS PHARMACY #085
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, PHARMACY
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 1:1000 S 2ND ST
Mailing Address - Street 2:P.O. BOX 471
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3318
Mailing Address - Country:US
Mailing Address - Phone:570-286-3623
Mailing Address - Fax:570-988-3774
Practice Address - Street 1:7848 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3338
Practice Address - Country:US
Practice Address - Phone:410-282-1725
Practice Address - Fax:410-282-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP072123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD300307800Medicaid
MD2140490OtherNCPDP
MD300307800Medicaid