Organization
WILEY'S PHARMACY & COMPOUNDING SERVICES INC
Active
Other names
Masons' Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY COPELAND (OFFICE MANAGER)
(318) 396-1812
Entity
Organization
Contact information
Practice address
2403 ARKANSAS RD, WEST MONROE, LA 71291-8611
(318) 396-1812
(318) 396-5602
Mailing address
2403 ARKANSAS RD, WEST MONROE, LA 71291-8611
(318) 396-1812
(318) 396-5602
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHY005903IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1217051
—
LA
01
—
1935963
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/01/2011
Last updated
12/01/2011
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