Provider Demographics
NPI:1699729418
Name:WILBUR DRUG, INC.
Entity type:Organization
Organization Name:WILBUR DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-647-2034
Mailing Address - Street 1:2 SW MAIN AVE
Mailing Address - Street 2:P.O.BOX 1092
Mailing Address - City:WILBUR
Mailing Address - State:WA
Mailing Address - Zip Code:99185-1092
Mailing Address - Country:US
Mailing Address - Phone:509-647-2034
Mailing Address - Fax:509-647-2034
Practice Address - Street 1:2 SW MAIN AVE
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99185-1092
Practice Address - Country:US
Practice Address - Phone:509-647-2034
Practice Address - Fax:509-647-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000036133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14710OtherL&I NUMBER
WACF00003613OtherPHARMACY LICENSE
WA6138606Medicaid
WA4911485OtherNCPDP NUMBER
WA4911485OtherNCPDP NUMBER
WA14710OtherL&I NUMBER