MEDICARE: GANSE APOTHECARY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PP410289L	PA
2	3336L0003X	Long Term Care Pharmacy
3	3336S0011X	Specialty Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3909706	OTHER	PA	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558395533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANSE APOTHECARY LLC

Provider Business Mailing Address
First Line	:	355 W KING ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3751
Country	:	US
Telephone Number	:	717-394-5671
Fax Number	:	717-394-4566

Provider Business Practice Location Address
First Line	:	21 N CHARLOTTE ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3702
Country	:	US
Telephone Number	:	717-394-5671
Fax Number	:	717-394-4566

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	GREG GANSE
Credential	:
Telephone Number	:	717-394-5671

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/30/2024

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Directions to “GANSE APOTHECARY LLC ” Practice Location

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