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General NPI Number Information
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NPI Number | 1073678850
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Entity Type | Organization
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Legal Business Name | EDWARD S. WILCOX
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 1009 MAIN ST
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City | REPUBLIC
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State | PA
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Zip | 15475
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Country | US
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Telephone | 724-246-8800
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Fax | 724-246-5050
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Provider Business Mailing Address
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Address Line | 1009 MAIN ST
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City | REPUBLIC
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State | PA
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Zip | 15475
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Country | US
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Telephone | 724-246-8800
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Fax | 724-246-5050
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. EDWARD S WILCOX
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Credential | RPH
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Telephone | 724-246-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PP411751L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP411751L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP411751L
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License Number State | PA
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