Provider Demographics
NPI:1093295073
Name:VANEK, PAIGE MADISAN
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MADISAN
Last Name:VANEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2653
Mailing Address - Country:US
Mailing Address - Phone:724-628-8125
Mailing Address - Fax:724-628-5727
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
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450890183500000X
WVRP0009763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist