1033142369 NPI number — WEIS MARKETS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142369 NPI number — WEIS MARKETS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEIS MARKETS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEIS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033142369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 N 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19604-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-929-4747
Provider Business Practice Location Address Fax Number:
610-929-8677
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALTESE
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT PHARMACY
Authorized Official Telephone Number:
570-863-2809

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP413689L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007742100171 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3950397 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1022236 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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