Provider Demographics
NPI:1306831193
Name:WILEY PHARMACY OF MILLERSVILLE, INC.
Entity Type:Organization
Organization Name:WILEY PHARMACY OF MILLERSVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-871-1100
Mailing Address - Street 1:507 LEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1109
Mailing Address - Country:US
Mailing Address - Phone:717-871-1100
Mailing Address - Fax:717-871-6944
Practice Address - Street 1:507 LEAMAN AVE
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1109
Practice Address - Country:US
Practice Address - Phone:717-871-1100
Practice Address - Fax:717-871-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481102333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4395300001Medicare NSC