Provider Demographics
NPI:1558667469
Name:WILEY, FRIEDA YVONNE EUNICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FRIEDA
Middle Name:YVONNE EUNICE
Last Name:WILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-0654
Mailing Address - Country:US
Mailing Address - Phone:936-295-7989
Mailing Address - Fax:
Practice Address - Street 1:50 HARRISON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6064
Practice Address - Country:US
Practice Address - Phone:201-420-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist