Healthcare Provider Details

I. General information

NPI: 1356492177
Provider Name (Legal Business Name): WELLSPAN PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 BIGLERVILLE ROAD
BIGLERVILLE PA
17307
US

IV. Provider business mailing address

3460 BIGLERVILLE ROAD
BIGLERVILLE PA
17307
US

V. Phone/Fax

Practice location:
  • Phone: 717-677-6600
  • Fax: 717-677-9262
Mailing address:
  • Phone: 717-677-6600
  • Fax: 717-677-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410599L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP410599L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP410599L
License Number StatePA

VIII. Authorized Official

Name: MRS. MELISSA MOOK
Title or Position: DIRECTOR - WELLSPAN PHARMACY, INC.
Credential:
Phone: 717-851-5895