Healthcare Provider Details

I. General information

NPI: 1821188632
Provider Name (Legal Business Name): WILEYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 MAIN STREET
ALTAMONT TN
37301-0157
US

IV. Provider business mailing address

1595 MAIN STREET PO BOX 157
ALTAMONT TN
37301
US

V. Phone/Fax

Practice location:
  • Phone: 931-692-3888
  • Fax: 931-692-3889
Mailing address:
  • Phone: 931-692-3888
  • Fax: 931-692-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number96
License Number StateTN

VIII. Authorized Official

Name: LARRY A. WILEY
Title or Position: PHARMACIST/MANAGING MEMBER
Credential: DPH
Phone: 931-692-3888