=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629248794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEIS MARKETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2008
-----------------------------------------------------
Last Update Date | 08/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12817 SHANK FARM LN
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-2781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-665-9568
-----------------------------------------------------
Fax | 301-665-9798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 471
-----------------------------------------------------
City | SUNBURY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17801-0471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-286-3623
-----------------------------------------------------
Fax | 570-988-3774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP PHCY
-----------------------------------------------------
Name | JEFFERY MALTESE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 570-863-2809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P04745
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------