Provider Demographics
NPI:1083027023
Name:FLANAGIN, WILEY STEWART JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILEY
Middle Name:STEWART
Last Name:FLANAGIN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4613
Mailing Address - Country:US
Mailing Address - Phone:706-564-1995
Mailing Address - Fax:
Practice Address - Street 1:1117 GLENN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4613
Practice Address - Country:US
Practice Address - Phone:706-564-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist