Provider Demographics
NPI:1568700946
Name:WILEY, LAURA J (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:WILEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 CROSS OVER DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7993
Mailing Address - Country:US
Mailing Address - Phone:517-669-4610
Mailing Address - Fax:
Practice Address - Street 1:3594 E LAKE DR
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8725
Practice Address - Country:US
Practice Address - Phone:810-678-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410809183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist