Provider Demographics
NPI:1134175581
Name:GEISINGER PHARMACY LLC
Entity type:Organization
Organization Name:GEISINGER PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP ENTERPRISE PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
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 # MC24-01
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2401
Mailing Address - Country:US
Mailing Address - Phone:570-214-8503
Mailing Address - Fax:570-271-7953
Practice Address - Street 1:44 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8020
Practice Address - Country:US
Practice Address - Phone:570-214-8503
Practice Address - Fax:570-271-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414060L251F00000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1507155OtherGATEWAY PROVIDER #
PA243353OtherHIGHMARK BS PROVIDER #
PA1007535151387Medicaid
PA39JI10OtherKEYSTONE HEALTH CENTRAL
PAGE205242OtherGEISINGER HEALTH PLAN HMO
PA132447OtherUNISON HEALTH PLAN
PA09HI10OtherCAPITAL BLUE CROSS PROVID
PA1000038000024Medicaid
PA1038440050013Medicaid
PA181925OtherBCNEPA ACCESS CARE PROV #
PA362013OtherAETNA PROVIDER NUMBER
PA95862OtherHEALTH AMERICA PROVIDER #
PA996012OtherBC NEPA PROVIDER NUMBER