Provider Demographics
NPI:1598361123
Name:WILCHA, LAUREN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:WILCHA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:284 DUNDAFF ST
Mailing Address - Street 2:
Mailing Address - City:FELL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1585
Mailing Address - Country:US
Mailing Address - Phone:570-241-6046
Mailing Address - Fax:
Practice Address - Street 1:95 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2255
Practice Address - Country:US
Practice Address - Phone:570-241-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist