MEDICARE: WEIS MARKETS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	P02565	MD
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2124989	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1245263573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEIS MARKETS INC

Provider Business Mailing Address
First Line	:	1000 S 2ND ST
Second Line	:	PO BOX 471
City	:	SUNBURY
State	:	PA
Zip	:	17801-3318
Country	:	US
Telephone Number	:	570-286-3623
Fax Number	:	570-988-3774

Provider Business Practice Location Address
First Line	:	10825 BIRMINGHAM WAY
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-1427
Country	:	US
Telephone Number	:	410-461-7547
Fax Number	:	410-461-6473

Authorized Official
Title or Position	:	VICE PRESIDENT PHARMACY
Name	:	JEFFERY MALTESE
Credential	:	RPH
Telephone Number	:	570-863-2809

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/08/2008

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Directions to “WEIS MARKETS INC ” Practice Location

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