Provider Demographics
NPI:1578168381
Name:WILEY, JENNIFER B (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
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 1:33 KATHERINES WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1564
Mailing Address - Country:US
Mailing Address - Phone:717-471-8849
Mailing Address - Fax:
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?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042108L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP042108LOtherPHARMACY LICENSE