Healthcare Provider Details

I. General information

NPI: 1780340935
Provider Name (Legal Business Name): GEISINGER PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 WINDMERE DR
STATE COLLEGE PA
16801-7644
US

IV. Provider business mailing address

100 N ACADEMY AVE # MC24-01
DANVILLE PA
17822-2401
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-4057
  • Fax:
Mailing address:
  • Phone: 570-214-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL EVANS
Title or Position: VP ENTERPRISE PHARMACY
Credential:
Phone: 570-271-6192