NPIMap

Organization Active NPI

Wesclare Corporation

  • Community/Retail Pharmacy
  • Fairchance, PA
National Provider Identifier
1104984426
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP410720L Issued in PA
Legal business name
WESCLARE CORPORATION
Practice address
90 W Church St
Fairchance, PA 15436-1137
Phone
(724) 564-7817
Fax
(724) 564-5969
NPI assigned
Dec 6, 2006
Organization subpart
Yes
Parent organization
WESCLARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. James Wesley Nickman Jr.
Title
President
Phone
(724) 437-2144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PP410720L PA Primary

Addresses

Primary practice location

90 W Church St
Fairchance, PA 15436-1137

Mailing address

3 Nickman PLZ
Lemont Furnace, PA 15456-9732
Phone (724) 437-2144

Other identifiers 1

IdentifierTypeStateIssuer
0018740940002MedicaidPA

Other names 1

  • Nickman's Drug #129 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171005002282 PA Part B Supplier - Mass Immunization (Roster Biller Only) 3173736469 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Connellsville, PA; Fairchance, PA; Hopwood, PA; Lemont Furnace, PA; Masontown, PA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Wesclare Corporation7 organizations share this tax ID, including this one
Part of
Wesclare Corporation

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578960000000",
    "number": "1104984426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NICKMAN PLZ",
            "city": "LEMONT FURNACE",
            "state": "PA",
            "postal_code": "154569732",
            "telephone_number": "724-437-2144",
            "fax_number": "724-437-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 W CHURCH ST",
            "city": "FAIRCHANCE",
            "state": "PA",
            "postal_code": "154361137",
            "telephone_number": "724-564-7817",
            "fax_number": "724-564-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESCLARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESCLARE CORPORATION",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A",
        "authorized_official_last_name": "NICKMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-437-2144",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP410720L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018740940002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nickman's Drug #129",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairchance, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.