NPIMap

Organization Active NPI

Geisinger Wyoming Valley Medical Center

  • Community/Retail Pharmacy
  • Wilkes Barre, PA
National Provider Identifier
1831930338
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice address
950 E Mountain Blvd
Wilkes Barre, PA 18711-0028
Phone
(570) 808-0008
Fax
(570) 808-2836
NPI assigned
Jun 6, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Authorized official

Name
Michael A Evans
Title
Chief Pharmacy Officer
Phone
(570) 271-6192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

950 E Mountain Blvd
Wilkes Barre, PA 18711-0028

Mailing address

100 N Academy Ave
Danville, PA 17822-2404
Phone (570) 271-7965

Other identifiers 1

IdentifierTypeStateIssuer
1007584780040MedicaidPA

Other names 1

  • Geisinger Pharmacy MOB Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250321000441 PA DME Supplier - Pharmacy 5092780023 Practice locations: Wilkes Barre, PA

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Geisinger Wyoming Valley Medical Ce950 E Mountain Blvd, Wilkes Barre, PA 18711-0028(570) 808-0008 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Feb 24, 2017

National Provider Directory

National Provider Directory
Tax ID family
Rad NPW Fund23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1831930338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178222404",
            "telephone_number": "570-271-7965",
            "fax_number": "570-271-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110028",
            "telephone_number": "570-808-0008",
            "fax_number": "570-808-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER WYOMING VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-06",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "570-271-6192"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007584780040",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geisinger Pharmacy MOB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Geisinger Pharmacy MOB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.