NPIMap

Organization Active NPI

Wellspan Pharmacy Inc

Doing business as Wellspan Pharmacy

  • Community/Retail Pharmacy
  • Fairfield, PA
National Provider Identifier
1689754079
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP415301L Issued in PA
Legal business name
WELLSPAN PHARMACY INC
Doing business as
Wellspan Pharmacy
Practice address
4910 Fairfield Rd Ste B
Suite 2
Fairfield, PA 17320-9510
Phone
(717) 642-8812
Fax
(717) 642-6691
NPI assigned
Oct 17, 2006
Last updated
Aug 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Authorized official

Name
Mr. Kevin Charnetski, PHARMDNPI 1952712408
Title
Director
Phone
(570) 262-6663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PP415301L PA
Community/Retail Pharmacy 3336C0003X PP415301L PA Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

4910 Fairfield Rd Ste B
Suite 2
Fairfield, PA 17320-9510

Mailing address

PO Box 20129
York, PA 17402-0140
Phone (717) 851-6903

Other identifiers 3

IdentifierTypeStateIssuer
1007431520005MedicaidPA
3973282OtherPANABP#
PP415301LOtherPAPHARMACY LICENSE

Other names 1

  • Wellspan Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20100930094977 PA DME Supplier - Pharmacy 2264588730 Practice locations: Fairfield, PA

Other NPIs with the same Medicare PAC ID 3

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

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 Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1689754079",
    "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": "4910 FAIRFIELD RD STE B",
            "address_2": "SUITE 2",
            "city": "FAIRFIELD",
            "state": "PA",
            "postal_code": "173209510",
            "telephone_number": "717-642-8812",
            "fax_number": "717-642-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "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": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "PP415301L",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP415301L",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007431520005",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP#",
            "identifier": "3973282",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PP415301L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellspan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, 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.

Verify at the official NPI Registry.