=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609739366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEIS MARKETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4535 FAIRWAY VILLAGE PL
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 227-722-4156
-----------------------------------------------------
Fax | 227-722-4157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 S 2ND ST
-----------------------------------------------------
City | SUNBURY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17801-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-286-3623
-----------------------------------------------------
Fax | 570-988-3774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, PHARMACY
-----------------------------------------------------
Name | NICHOLAS J. CICCO
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 570-286-3201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------