Provider Demographics
NPI:1558395533
Name:GANSE APOTHECARY LLC
Entity type:Organization
Organization Name:GANSE APOTHECARY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-394-5671
Mailing Address - Street 1:355 W KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3751
Mailing Address - Country:US
Mailing Address - Phone:717-394-5671
Mailing Address - Fax:717-394-4566
Practice Address - Street 1:21 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3702
Practice Address - Country:US
Practice Address - Phone:717-394-5671
Practice Address - Fax:717-394-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410289L3336C0003X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3909706OtherNCPDP
PA0005831360002Medicaid
PA4127810001Medicare ID - Type Unspecified