Provider Demographics
NPI:1346919859
Name:WILEY, JAMAL KENYATTA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:KENYATTA
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 1:4505 SENEY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6571
Mailing Address - Country:US
Mailing Address - Phone:615-579-4369
Mailing Address - Fax:
Practice Address - Street 1:7217 TELECOM PKWY STE 190
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2203
Practice Address - Country:US
Practice Address - Phone:469-814-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist