Provider Demographics
NPI:1639645690
Name:WILEY, JESSICA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
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 1:116 CARNIVAL DR
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2414
Mailing Address - Country:US
Mailing Address - Phone:443-277-9460
Mailing Address - Fax:
Practice Address - Street 1:116 CARNIVAL DR
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2178
Practice Address - Country:US
Practice Address - Phone:443-277-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist