NPIMap

Organization Active NPI

Wesclare Corporation

Doing business as Nickman's Drug #119

  • Community/Retail Pharmacy
  • Connellsville, PA
National Provider Identifier
1962435016
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP481096 Issued in PA
Legal business name
WESCLARE CORPORATION
Doing business as
Nickman's Drug #119
Practice address
107 Memorial Blvd
Connellsville, PA 15425-2653
Phone
(724) 628-8125
Fax
(724) 628-5727
NPI assigned
Jul 9, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WESCLARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 PP481096 PA Primary

Addresses

Primary practice location

107 Memorial Blvd
Connellsville, PA 15425-2653

Mailing address

3 Nickman's Plaza
Lemont Furnace, PA 15456
Phone (724) 437-2144

Other identifiers 3

IdentifierTypeStateIssuer
0018740940001MedicaidPA
PP481096OtherPASTATE PHARMACY
3979878OtherPANCPDP

Other names 1

  • Nickman's Drug #119 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930083396 PA DME Supplier - Pharmacy 3173736469 Practice locations: Connellsville, PA
O20171005002282 PA Part B Supplier - Mass Immunization (Roster Biller Only) 3173736469 4 other NPIs on this 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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wesclare Corporation107 Memorial Blvd, Connellsville, PA 15425-2653(724) 628-8125 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 1, 2019

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.

Locations

107 Memorial Blvd
Connellsville, PA 15425
Phone (724) 628-8125

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1962435016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NICKMAN'S PLAZA",
            "city": "LEMONT FURNACE",
            "state": "PA",
            "postal_code": "15456",
            "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": "107 MEMORIAL BLVD",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154252653",
            "telephone_number": "724-628-8125",
            "fax_number": "724-628-5727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESCLARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESCLARE CORPORATION",
        "enumeration_date": "2006-07-09",
        "last_updated": "2023-03-07",
        "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": "PP481096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018740940001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY",
            "identifier": "PP481096",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3979878",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nickman's Drug #119",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Connellsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.