Provider Demographics
NPI:1821188632
Name:WILEYS LLC
Entity Type:Organization
Organization Name:WILEYS LLC
Other - Org Name:WILEY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-692-3888
Mailing Address - Street 1:1595 MAIN STREET
Mailing Address - Street 2:PO BOX 157
Mailing Address - City:ALTAMONT
Mailing Address - State:TN
Mailing Address - Zip Code:37301
Mailing Address - Country:US
Mailing Address - Phone:931-692-3888
Mailing Address - Fax:931-692-3889
Practice Address - Street 1:1595 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:TN
Practice Address - Zip Code:37301-0157
Practice Address - Country:US
Practice Address - Phone:931-692-3888
Practice Address - Fax:931-692-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3547472Medicaid
TN5038920001Medicare NSC