MEDICARE: MRS. DELOIS JEAN 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	23526	TX

General Provider Information

NPI Number	:	1386956951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELOIS JEAN WILEY RPH

Provider Business Mailing Address
First Line	:	8800 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5633
Country	:	US
Telephone Number	:	713-784-8130
Fax Number	:	713-784-0103

Provider Business Practice Location Address
First Line	:	8800 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5633
Country	:	US
Telephone Number	:	713-784-8130
Fax Number	:	713-784-0103

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

Provider Enumeration Date	:	07/11/2010
Last Update Date	:	07/11/2010

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