Provider Demographics
NPI:1588970016
Name:IYINBOR, WILSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:IYINBOR
Suffix:
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 1:32 HAMPSHIRE GLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4805
Mailing Address - Country:US
Mailing Address - Phone:757-358-1221
Mailing Address - Fax:
Practice Address - Street 1:10818 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3741
Practice Address - Country:US
Practice Address - Phone:757-596-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist