Healthcare Provider Details

I. General information

NPI: 1558395533
Provider Name (Legal Business Name): GANSE APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N CHARLOTTE ST
LANCASTER PA
17603-3702
US

IV. Provider business mailing address

355 W KING ST
LANCASTER PA
17603-3751
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-5671
  • Fax: 717-394-4566
Mailing address:
  • Phone: 717-394-5671
  • Fax: 717-394-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410289L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREG GANSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 717-394-5671