MEDICARE: WILEYS PHARMACY AND COMPOUNDING SERVICE INC

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	3336C0003X	Community/Retail Pharmacy	PHY.005903-IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1916090	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598845604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILEYS PHARMACY AND COMPOUNDING SERVICE INC

Provider Business Mailing Address
First Line	:	2403 ARKANSAS RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-8611
Country	:	US
Telephone Number	:	318-396-1812
Fax Number	:	318-396-5602

Provider Business Practice Location Address
First Line	:	2403 ARKANSAS RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-8611
Country	:	US
Telephone Number	:	318-396-1812
Fax Number	:	318-396-5602

Authorized Official
Title or Position	:	SECRETARY
Name	:	ANGELA WILEY
Credential	:	RPH
Telephone Number	:	318-396-1812

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/03/2016

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