MEDICARE: DR. FRIEDA YVONNE EUNICE WILEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	48702	TX

General Provider Information

NPI Number	:	1558667469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRIEDA YVONNE EUNICE WILEY PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 654
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77342-0654
Country	:	US
Telephone Number	:	936-295-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 HARRISON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6064
Country	:	US
Telephone Number	:	201-420-6686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	11/11/2012

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