Healthcare Provider Details

I. General information

NPI: 1114950441
Provider Name (Legal Business Name): WEIS MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 KINGS PLZ
OLEY PA
19547-8718
US

IV. Provider business mailing address

1000 S 2ND ST PO BOX 471
SUNBURY PA
17801-3318
US

V. Phone/Fax

Practice location:
  • Phone: 610-987-9877
  • Fax: 610-987-3614
Mailing address:
  • Phone: 570-286-3623
  • Fax: 570-988-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414169L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY MALTESE
Title or Position: VICE PRESIDENT PHARMACY
Credential: RPH
Phone: 570-863-2809