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General NPI Number Information
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NPI Number | 1003196130
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Entity Type | Individual
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Provider Name | CASEY JAMES WILBERT PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/20/2011
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Last Update Date | 08/20/2011
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Provider Practice Location Address
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Address Line | 400 N STATE OF FRANKLIN RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6035
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Country | US
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Telephone | 423-431-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 SKYLINE DR APT L 74
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4344
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Country | US
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Telephone | 315-796-5852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36147
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License Number State | TN
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