Provider Demographics
NPI:1104984426
Name:WESCLARE CORPORATION
Entity type:Organization
Organization Name:WESCLARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:NICKMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:724-437-2144
Mailing Address - Street 1:3 NICKMAN PLZ
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-9732
Mailing Address - Country:US
Mailing Address - Phone:724-437-2144
Mailing Address - Fax:724-437-8303
Practice Address - Street 1:90 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRCHANCE
Practice Address - State:PA
Practice Address - Zip Code:15436-1137
Practice Address - Country:US
Practice Address - Phone:724-564-7817
Practice Address - Fax:724-564-5969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESCLARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410720L3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018740940002Medicaid
2133442OtherPK