Individual
COLLETTE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
(417) 863-8756
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
(417) 863-8756
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
044549
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FEDERAL TAX ID
43-1602701
MO
01
—
NCPDP
2619522
MO
Enumeration date
07/22/2011
Last updated
07/22/2011
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