Provider Demographics
NPI:1184216095
Name:WASANG, VALERY
Entity Type:Individual
Prefix:
First Name:VALERY
Middle Name:
Last Name:WASANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1413
Mailing Address - Country:US
Mailing Address - Phone:717-593-0170
Mailing Address - Fax:717-593-0712
Practice Address - Street 1:305 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1413
Practice Address - Country:US
Practice Address - Phone:717-593-0170
Practice Address - Fax:717-593-0712
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP154169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist