Provider Demographics
NPI:1801831326
Name:GEISINGER MEDICAL CENTER
Entity Type:Organization
Organization Name:GEISINGER MEDICAL CENTER
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 1:100 N ACADEMY AVE
Practice Address - Street 2:M.C.15-42
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1542
Practice Address - Country:US
Practice Address - Phone:570-271-6451
Practice Address - Fax:570-271-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X
PAHP418073L3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007478860050Medicaid
2079701OtherPK