Healthcare Provider Details

I. General information

NPI: 1962435016
Provider Name (Legal Business Name): WESCLARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MEMORIAL BLVD
CONNELLSVILLE PA
15425-2653
US

IV. Provider business mailing address

3 NICKMAN'S PLAZA
LEMONT FURNACE PA
15456
US

V. Phone/Fax

Practice location:
  • Phone: 724-628-8125
  • Fax: 724-628-5727
Mailing address:
  • Phone: 724-437-2144
  • Fax: 724-437-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481096
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES WESLEY NICKMAN JR.
Title or Position: PRESIDENT
Credential:
Phone: 724-437-2144