Healthcare Provider Details

I. General information

NPI: 1912906165
Provider Name (Legal Business Name): DERMSCENE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 FRANKFORD AVE
PHILADELPHIA PA
19135-2538
US

IV. Provider business mailing address

6519 FRANKFORD AVE
PHILADELPHIA PA
19135-2538
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-4224
  • Fax: 215-624-4416
Mailing address:
  • Phone: 215-624-4224
  • Fax: 215-624-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028768L
License Number StatePA

VIII. Authorized Official

Name: DR. LANCE MARTIN WETZEL JR.
Title or Position: PRESIDENT
Credential: PHARM.D
Phone: 215-624-4224