Provider Demographics
NPI:1235728346
Name:WILEY, AMBER NICOLE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4437
Mailing Address - Country:US
Mailing Address - Phone:254-776-1027
Mailing Address - Fax:
Practice Address - Street 1:1301 WOODED ACRES DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4437
Practice Address - Country:US
Practice Address - Phone:254-776-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician