MEDICARE: JESSICA WILEY RPH

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	13779	NC

General Provider Information

NPI Number	:	1073844098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WILEY RPH

Provider Business Mailing Address
First Line	:	4620 WOODY MILL RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8779
Country	:	US
Telephone Number	:	336-674-5518
Fax Number	:	336-674-5590

Provider Business Practice Location Address
First Line	:	4620 WOODY MILL RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8779
Country	:	US
Telephone Number	:	336-674-5518
Fax Number	:	336-674-5590

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	09/11/2014

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