Provider Demographics
NPI:1407196926
Name:WESCLARE CORPORATION
Entity Type:Organization
Organization Name:WESCLARE CORPORATION
Other - Org Name:NICKMAN'S DRUG
Other - Org Type:Doing Business As
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 PLZ
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-9732
Mailing Address - Country:US
Mailing Address - Phone:724-437-2144
Mailing Address - Fax:724-437-8303
Practice Address - Street 1:1878 MCCLELLANDTOWN RD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-2508
Practice Address - Country:US
Practice Address - Phone:724-952-1040
Practice Address - Fax:724-952-1044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESCLARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-20
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018740940003Medicaid