Provider Demographics
NPI:1548709561
Name:GEISINGER PHARMACY, LLC
Entity type:Organization
Organization Name:GEISINGER PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-RETAIL AND MAIL ORDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6912
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2575
Mailing Address - Country:US
Mailing Address - Phone:570-271-7965
Mailing Address - Fax:570-271-7370
Practice Address - Street 1:210 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:ELYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17824-9770
Practice Address - Country:US
Practice Address - Phone:844-878-5562
Practice Address - Fax:570-221-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827083336M0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007535151365Medicaid
2167984OtherPK