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General NPI Number Information
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NPI Number | 1790060929
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Entity Type | Individual
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Provider Name | BROCK ELLIOT WILEY PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 103 W 2ND ST
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City | KENLY
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State | NC
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Zip | 27542-5004
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Country | US
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Telephone | 919-284-2010
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Fax | 919-284-2231
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Provider Business Mailing Address
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Address Line | PO BOX 235
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City | KENLY
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State | NC
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Zip | 27542-0235
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Country | US
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Telephone | 919-284-2010
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Fax | 919-284-2231
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19919
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License Number State | NC
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