Provider Demographics
NPI:1871645580
Name:WELLSPAN PHARMACY, INC
Entity Type:Organization
Organization Name:WELLSPAN PHARMACY, INC
Other - Org Name:WELLSPAN PHARMACY - APPLE HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARNETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-262-6663
Mailing Address - Street 1:PO BOX 20129
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-0140
Mailing Address - Country:US
Mailing Address - Phone:717-851-6903
Mailing Address - Fax:717-851-5407
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 265
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8151
Practice Address - Fax:717-741-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414007L332B00000X, 333600000X, 3336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007746500010Medicaid
PA0325770001OtherMEDICARE PART B
PA1007746500010Medicaid
PA0325770001Medicare NSC