Healthcare Provider Details

I. General information

NPI: 1174656177
Provider Name (Legal Business Name): G. SPEARING WEISS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 RT 940 SUITE 1
BLAKESLEE PA
18610
US

IV. Provider business mailing address

PO BOX 648
BLAKESLEE PA
18610
US

V. Phone/Fax

Practice location:
  • Phone: 570-646-8040
  • Fax: 570-643-9031
Mailing address:
  • Phone: 570-646-8040
  • Fax: 570-643-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP412175L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GLENN S. WEISS
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 570-646-8040