Provider Demographics
NPI:1063856052
Name:WILEY, BRETT JOSEPH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JOSEPH
Last Name:WILEY
Suffix:
Gender:M
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 1:1095 MAIN ST
Mailing Address - Street 2:APT 1
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1215
Mailing Address - Country:US
Mailing Address - Phone:304-784-7835
Mailing Address - Fax:
Practice Address - Street 1:340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1508
Practice Address - Country:US
Practice Address - Phone:304-397-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV8030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist