Provider Demographics
NPI:1174812960
Name:WIENCKOSKI, MARIA JO (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JO
Last Name:WIENCKOSKI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 COON RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-6043
Mailing Address - Country:US
Mailing Address - Phone:570-333-4366
Mailing Address - Fax:
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2000
Practice Address - Country:US
Practice Address - Phone:570-655-4030
Practice Address - Fax:570-654-2414
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-037091L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist