Active NPI
Wellspan Pharmacy Inc
- Community/Retail Pharmacy
- Lebanon, PA
National Provider Identifier
1477095172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- WELLSPAN PHARMACY INC
- Practice address
- 252 S 4TH St
Lebanon, PA 17042-6111 - Phone
- (717) 741-8151
- NPI assigned
- Nov 11, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Kevin Charnetski, PHARM D
- Title
- Director
- Phone
- (570) 262-6663
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
252 S 4TH St
Lebanon, PA 17042-6111
Mailing address
PO Box 20129
York, PA 17402-0140
Phone (717) 851-6903
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007746500016 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090924000486 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2264588730 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fairfield, PA; Gettysburg, PA; Lebanon, PA; York, PA; Ephrata, PA |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember 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": "1478822400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1786665600000",
"number": "1477095172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20129",
"city": "YORK",
"state": "PA",
"postal_code": "174020140",
"telephone_number": "717-851-6903",
"fax_number": "717-851-5407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "252 S 4TH ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "170426111",
"telephone_number": "717-741-8151"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLSPAN PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-11-11",
"last_updated": "2026-08-14",
"certification_date": "2026-08-14",
"status": "A",
"authorized_official_last_name": "CHARNETSKI",
"authorized_official_first_name": "KEVIN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "570-262-6663",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "PHARM D"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007746500016",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.