Provider Demographics
NPI:1396052189
Name:WILBUR, STEPHEN (STEPHEN WILBUR)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WILBUR
Suffix:
Gender:M
Credentials:STEPHEN WILBUR
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:WILBUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STEPHEN WILBUR
Mailing Address - Street 1:2676 E OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-9143
Mailing Address - Country:US
Mailing Address - Phone:480-926-9170
Mailing Address - Fax:
Practice Address - Street 1:420 S SOSSAMAN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2001
Practice Address - Country:US
Practice Address - Phone:480-325-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist