Provider Demographics
NPI:1801499363
Name:WILES, JERRY HENRY III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HENRY
Last Name:WILES
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-1914
Mailing Address - Country:US
Mailing Address - Phone:864-642-7480
Mailing Address - Fax:
Practice Address - Street 1:845 S BUNCOMBE RD STE B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2432
Practice Address - Country:US
Practice Address - Phone:864-522-1700
Practice Address - Fax:864-522-1724
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT37717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist