=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700773397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESCLARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 3RD ST
-----------------------------------------------------
City | CALIFORNIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15419-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-938-3515
-----------------------------------------------------
Fax | 724-938-0381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 NICKMAN PLZ
-----------------------------------------------------
City | LEMONT FURNACE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15456-9732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-780-2021
-----------------------------------------------------
Fax | 844-309-9254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAMES WESLEY NICKMAN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-780-2021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------