Organization
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA FORMICA (CHIEF FINANCIAL OFFICER)
(717) 367-1121
Entity
Organization
Contact information
Practice address
581 FREEMASON DR, ELIZABETHTOWN, PA 17022-3187
(717) 367-1121
(717) 367-5813
Mailing address
1 MASONIC DR, ELIZABETHTOWN, PA 17022-2199
(717) 367-1121
(717) 367-5813
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
000634A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220002197
RAILROAD PIN
—
01
—
39D0657302
CLIA
PA
Enumeration date
10/25/2012
Last updated
05/01/2023
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