Provider Demographics
NPI:1518240522
Name:WILEY, WILLIAM DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAVID
Last Name:WILEY
Suffix:
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 1:1001 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KS
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-651-0471
Mailing Address - Fax:270-659-0147
Practice Address - Street 1:1001 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KS
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-0471
Practice Address - Fax:270-659-0147
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist