Healthcare Provider Details

I. General information

NPI: 1356262398
Provider Name (Legal Business Name): KIMBERLY WILEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY DEJARNETTE PHARM.D.

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8468 SENECA TRL S
RONCEVERTE WV
24970-9626
US

IV. Provider business mailing address

155 POTOMAC CROSSWAY
LEWISBURG WV
24901-5122
US

V. Phone/Fax

Practice location:
  • Phone: 681-214-7774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: