Provider Demographics
NPI:1568457158
Name:WILEY, JOHN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:WILEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 TOWNSEDGE DR
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-1300
Mailing Address - Country:US
Mailing Address - Phone:717-786-1191
Mailing Address - Fax:717-786-1228
Practice Address - Street 1:112 TOWNSEDGE DR
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1300
Practice Address - Country:US
Practice Address - Phone:717-786-1191
Practice Address - Fax:717-786-1228
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042014L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist