Provider Demographics
NPI:1144253477
Name:WEIS MARKETS INC
Entity type:Organization
Organization Name:WEIS MARKETS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-863-2812
Mailing Address - Street 1:1000 S 2ND ST
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3318
Mailing Address - Country:US
Mailing Address - Phone:570-286-3623
Mailing Address - Fax:570-988-3774
Practice Address - Street 1:1105 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2211
Practice Address - Country:US
Practice Address - Phone:570-759-0896
Practice Address - Fax:570-752-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411935L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742100231Medicaid
3940322OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0569816Medicaid
0349270037Medicare NSC