Provider Demographics
NPI:1639102965
Name:WEIS MARKETS INC
Entity Type:Organization
Organization Name:WEIS MARKETS INC
Other - Org Name:WEIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-863-2809
Mailing Address - Street 1:1000 S 2ND ST
Mailing Address - Street 2:PO 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 1:553 MAHONING ST # 555
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-2213
Practice Address - Country:US
Practice Address - Phone:570-742-8253
Practice Address - Fax:570-742-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415440L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1723008Medicaid
3975212OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007742100052Medicaid
PA1007742100052Medicaid