Provider Demographics
NPI:1952623274
Name:EPHRATA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Name:WELLSPAN CANCER CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-738-2517
Mailing Address - Street 1:169 MARTIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1002
Mailing Address - Country:US
Mailing Address - Phone:717-738-2517
Mailing Address - Fax:717-733-9442
Practice Address - Street 1:169 MARTIN AVENUE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1002
Practice Address - Country:US
Practice Address - Phone:717-738-2517
Practice Address - Fax:717-733-9442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRATA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-01
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0004X, 3336I0012X, 3336S0011X
PAPP4811183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3993373OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA3993373OtherNCPDP PROVIDER ID