Provider Demographics
NPI:1962435016
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'S PLAZA
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456
Mailing Address - Country:US
Mailing Address - Phone:724-437-2144
Mailing Address - Fax:724-437-8303
Practice Address - Street 1:107 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2653
Practice Address - Country:US
Practice Address - Phone:724-628-8125
Practice Address - Fax:724-628-5727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESCLARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4810963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018740940001Medicaid
PA3979878OtherNCPDP
PAPP481096OtherSTATE PHARMACY
PAPP481096OtherSTATE PHARMACY
PA0018740940001Medicaid