Masonic Villages of the Grand Lodge of Pennsylvania

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

HP416534L Issued in PA

Legal business name

MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA

Practice address

1 Masonic Dr
Elizabethtown, PA 17022-2199

Phone

(717) 367-1121

Fax

(717) 367-5813

NPI assigned

Oct 30, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Pamela Formica, CPA

Title

Chief Financial Officer

Phone

(717) 367-1121

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Masonic Village Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jess Allen Lee, PHD

  • Psychologist
  • Elizabethtown, PA
  • NPI 1992955629
  NPD

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772496000000",
    "number": "1659625580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 MASONIC DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222573",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MASONIC DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222199",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A",
        "authorized_official_last_name": "FORMICA",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "717-367-1121",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "PA",
            "license": "HP416534L",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "HP416534L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3998741",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "HP416534L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Masonic Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Manor Care of Elizabethtown PA LLC
• Haley Lynn Martin, PHARMD
• Lauren Ann Martin, DPT
• Zachary David Martin, PA-C
• Carolina Martinez
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• Masonic Villages of the Grand Lodge of Pennsylvania
• John J Mast, M.D.

• Long Term Care Pharmacy in Elizabethtown, PA
• Providers in Elizabethtown, PA by specialty
• Long Term Care Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.