Provider Demographics
NPI:1003954488
Name:WYCOMBE PHARMACY INC.
Entity Type:Organization
Organization Name:WYCOMBE PHARMACY INC.
Other - Org Name:LEHIGH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:SCOTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-225-7522
Mailing Address - Street 1:1006 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-1640
Mailing Address - Country:US
Mailing Address - Phone:215-225-7522
Mailing Address - Fax:215-225-7525
Practice Address - Street 1:1006 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-1640
Practice Address - Country:US
Practice Address - Phone:215-225-7522
Practice Address - Fax:215-225-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW1007398660003Medicaid
PA1003954488OtherNPI
PAPP481048OtherLISCENSE
PA3979640OtherNCPDP #
PA3979640OtherNCPDP #
PABL7502342OtherDEA #
PA6359700001Medicare NSC