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General NPI Number Information
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NPI Number | 1184618092
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Entity Type | Individual
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Provider Name | KEVIN WILBUR PHARM.D., R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 164 SUMMIT AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-1352
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Country | US
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Telephone | 401-793-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 164 SUMMIT AVE.
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-793-5500
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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 | RPH04245
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 025236
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RPH04245
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License Number State | RI
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