MEDICARE: DR. AMBER DIONE WILBANKS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	E-09487	MS

General Provider Information

NPI Number	:	1730184607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER DIONE WILBANKS PHARMD

Provider Business Mailing Address
First Line	:	500 AVALON WAY
Second Line	:	APT 1315
City	:	BRANDON
State	:	MS
Zip	:	39047-7591
Country	:	US
Telephone Number	:	601-992-8408
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 TERRY RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-4956
Country	:	US
Telephone Number	:	601-992-8408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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