Active NPI
Mary Jo Weidenbaum
- Pharmacist
- Brodheadsville, PA
National Provider Identifier
1639775240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP035615T
- Practice address
- CVS Pharmacy
RT 209 and 115
Brodheadsville, PA 18322 - Phone
- (570) 992-6454
- NPI assigned
- Dec 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP035615T | PA | Primary |
Addresses
Primary practice location
CVS Pharmacy
RT 209 and 115
Brodheadsville, PA 18322
Mailing address
PO Box 1120
Brodheadsville, PA 18322-1120
Phone (570) 992-6454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP035615T | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1639775240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1120",
"city": "BRODHEADSVILLE",
"state": "PA",
"postal_code": "183221120",
"telephone_number": "570-992-6454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CVS PHARMACY",
"address_2": "RT 209 AND 115",
"city": "BRODHEADSVILLE",
"state": "PA",
"postal_code": "18322",
"telephone_number": "570-992-6454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDENBAUM",
"first_name": "MARY JO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP035615T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brodheadsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.