Provider Demographics
NPI:1770872731
Name:WEIS MARKETS INC
Entity type:Organization
Organization Name:WEIS MARKETS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-863-2809
Mailing Address - Street 1:1000 S 2ND ST
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3318
Mailing Address - Country:US
Mailing Address - Phone:570-286-3623
Mailing Address - Fax:570-988-3774
Practice Address - Street 1:1112 W WYOMISSING BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-2259
Practice Address - Country:US
Practice Address - Phone:610-775-3409
Practice Address - Fax:610-775-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742100288Medicaid
PA3995276OtherNCPDP
PA3995276OtherNCPDP