NPIMap

Organization Active NPI

Geisinger Pharmacy, LLC

  • Community/Retail Pharmacy
  • Dallas, PA
National Provider Identifier
1003107384
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP482126 Issued in PA
Legal business name
GEISINGER PHARMACY, LLC
Practice address
114 LT Michael Cleary Dr
Dallas, PA 18612-1649
Phone
(570) 255-1167
Fax
(570) 255-1169
NPI assigned
Apr 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael A Evans
Title
VP Enterprise Pharmacy
Phone
(570) 271-6192

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PP482126 PA Primary

Addresses

Primary practice location

114 LT Michael Cleary Dr
Dallas, PA 18612-1649

Mailing address

100 N Academy Ave
Danville, PA 17822-2575
Phone (570) 271-7965

Other identifiers 2

IdentifierTypeStateIssuer
2130034OtherPK
1007535151292MedicaidPA

Other names 1

  • Geisinger Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201221001901 PA DME Supplier - Pharmacy 0244640126 Practice locations: Dallas, PA

Other NPIs with the same Medicare PAC ID 18

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Geisinger Pharmacy LLC114 LT Michael Cleary Dr, Dallas, PA 18612-1649(570) 255-1167 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jan 7, 2021

National Provider Directory

National Provider Directory
Tax ID family
Geisingr Pharmacy LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1003107384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178222575",
            "telephone_number": "570-271-7965",
            "fax_number": "570-271-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 LT MICHAEL CLEARY DR",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121649",
            "telephone_number": "570-255-1167",
            "fax_number": "570-255-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-21",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP ENTERPRISE PHARMACY",
        "authorized_official_telephone_number": "570-271-6192"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130034",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007535151292",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geisinger Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.