Provider Demographics
NPI:1013953454
Name:GEISINGER PHARMACY, LLC
Entity Type:Organization
Organization Name:GEISINGER PHARMACY, LLC
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:570-271-7319
Practice Address - Street 1:21 GEISINGER LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-3400
Practice Address - Country:US
Practice Address - Phone:717-242-4264
Practice Address - Fax:717-242-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP481195L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126057OtherPK
PA1007535151282Medicaid
PA1007535151282Medicaid