Organization
WELLSPAN PHARMACY INC
Active
Other names
Wellspan Pharmacy - Fairfield, Wellspan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN CHARNETSKI PHARMD (SENIOR PHARMACY MANAGER)
(570) 262-6663
Entity
Organization
Contact information
Practice address
4910 FAIRFIELD RD STE B, SUITE 2, FAIRFIELD, PA 17320-9510
(717) 642-8812
(717) 642-6691
Mailing address
PO BOX 20129, YORK, PA 17402-0140
(717) 851-6903
(717) 851-5407
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP415301L
PA
333600000X
Pharmacy
PP415301L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP415301L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007431520005
—
PA
01
—
3973282
NABP#
PA
01
—
PP415301L
PHARMACY LICENSE
PA
Enumeration date
10/17/2006
Last updated
11/02/2023
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