Provider Demographics
NPI:1275684516
Name:WELLSPAN PHARMACY, INC.
Entity Type:Organization
Organization Name:WELLSPAN PHARMACY, INC.
Other - Org Name:WELLSPAN INFUSION SERVICES
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:
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:717-851-5891
Mailing Address - Fax:717-851-5897
Practice Address - Street 1:304 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4647
Practice Address - Country:US
Practice Address - Phone:717-851-5891
Practice Address - Fax:717-851-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415727L332B00000X, 332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA325770004OtherMEDICARE PART B
PA1007746500001Medicaid
PA0325770004Medicare NSC