Provider Demographics
NPI:1952742983
Name:CWIKLA, CORY (PHARM D)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:CWIKLA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3722
Mailing Address - Country:US
Mailing Address - Phone:267-237-1188
Mailing Address - Fax:215-744-0333
Practice Address - Street 1:5872 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-3722
Practice Address - Country:US
Practice Address - Phone:267-237-1188
Practice Address - Fax:215-744-0333
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist