Organization
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Active
Other names
Masonic Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA FORMICA CPA (CHIEF FINANCIAL OFFICER)
(717) 367-1121
Entity
Organization
Contact information
Practice address
1 MASONIC DR, ELIZABETHTOWN, PA 17022-2199
(717) 367-1121
(717) 367-5813
Mailing address
99 MASONIC DR, ELIZABETHTOWN, PA 17022-2573
(717) 367-1121
(717) 367-5813
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
HP416534L
PA
3336L0003X
Long Term Care Pharmacy
Primary
HP416534L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3998741
NCPDP
—
01
—
HP416534L
PHARMACY LICENSE
PA
Enumeration date
10/30/2012
Last updated
03/03/2026
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