# MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Masonic Village Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659625580
- **Authorized official:** MS. PAMELA FORMICA CPA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (717) 367-1121

## Contact information

- **Practice address:** 1 MASONIC DR, ELIZABETHTOWN, PA 17022-2199
- **Practice address phone:** (717) 367-1121
- **Practice address fax:** (717) 367-5813
- **Mailing address:** 99 MASONIC DR, ELIZABETHTOWN, PA 17022-2573
- **Mailing address phone:** (717) 367-1121
- **Mailing address fax:** (717) 367-5813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | HP416534L | PA | — |
| 3336L0003X | Long Term Care Pharmacy | HP416534L | PA | Yes |

## Other

- **Enumeration date:** 10/30/2012
- **Last updated:** 03/03/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3998741 | NCPDP | — |
| 01 | — | HP416534L | PHARMACY LICENSE | PA |