Provider Demographics
NPI:1790770709
Name:WILEY PHARMACY OF QUARRYVILLE, INC.
Entity Type:Organization
Organization Name:WILEY PHARMACY OF QUARRYVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-786-1191
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415510L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017490780001Medicaid
PA1279250001Medicare NSC