Provider Demographics
NPI:1619961174
Name:WILEY, STEPHEN W (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:WILEY
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 HEMPFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1615
Mailing Address - Country:US
Mailing Address - Phone:717-898-8804
Mailing Address - Fax:717-898-0048
Practice Address - Street 1:903 NISSLEY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1472
Practice Address - Country:US
Practice Address - Phone:717-898-8804
Practice Address - Fax:717-898-0048
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP0292201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist