Provider Demographics
NPI:1881024958
Name:WILES, GARY K
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:K
Last Name:WILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:K
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1375 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4984
Mailing Address - Country:US
Mailing Address - Phone:479-750-7856
Mailing Address - Fax:
Practice Address - Street 1:1375 MARKET SQUARE DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4984
Practice Address - Country:US
Practice Address - Phone:479-750-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 064081835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist