Healthcare Provider Details

I. General information

NPI: 1184618092
Provider Name (Legal Business Name): KEVIN WILBUR PHARM.D., R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-1352
US

IV. Provider business mailing address

164 SUMMIT AVE.
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5500
  • Fax:
Mailing address:
  • Phone: 401-793-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04245
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025236
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH04245
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: