Provider Demographics
NPI:1306909569
Name:WILEY, MARGIE M
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:M
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LANE LAND
Mailing Address - Street 2:PO BOX 294
Mailing Address - City:CALVERT
Mailing Address - State:AL
Mailing Address - Zip Code:36513
Mailing Address - Country:US
Mailing Address - Phone:251-829-9316
Mailing Address - Fax:
Practice Address - Street 1:MT. VERNON PHARMACY
Practice Address - Street 2:19390 HWY 43 & MILDRED ST.
Practice Address - City:MT. VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560
Practice Address - Country:US
Practice Address - Phone:251-829-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other