Provider Demographics
NPI:1588997290
Name:SKALAK, WESLEY JOE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JOE
Last Name:SKALAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WOOD OAK TRL
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-8637
Mailing Address - Country:US
Mailing Address - Phone:817-594-8032
Mailing Address - Fax:
Practice Address - Street 1:106 WOOD OAK TRL
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-8637
Practice Address - Country:US
Practice Address - Phone:817-594-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43221183500000X
LA018754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist