G. Spearing Weiss LLC
Organization Active NPI Pharmacy · Blakeslee, PA
NPI 1174656177 · NPPES record last updated Oct 24, 2019
Key facts
- NPI
- 1174656177
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- PP412175L (PA)
- Legal business name
- G. SPEARING WEISS LLC
- Practice address
- 393 RT 940
Suite 1
Blakeslee, PA 18610 - Phone
- (570) 646-8040
- Fax
- (570) 643-9031
- NPI assigned
- Mar 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Glenn S. Weiss, RPH
- Title
- Pharmacist/Owner
- Phone
- (570) 646-8040
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191017000682 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7517298854 | Practice locations: Blakeslee, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | PP412175L | PA | Yes |
| Community/Retail Pharmacy | 3336C0003X | |||
| Compounding Pharmacy | 3336C0004X | |||
| Managed Care Organization Pharmacy | 3336M0003X |
Addresses
Primary practice location
393 RT 940
Suite 1
Blakeslee, PA 18610
Mailing address
PO Box 648
Blakeslee, PA 18610
Phone (570) 646-8040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7575708 | Medicaid | PA | |
| 2081195 | Other | PK |
Other names
- Blakeslee Pharmacy
Other providers in Blakeslee, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.