Provider Demographics
NPI:1619274784
Name:WILBERT, WILLIAM F (DPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:WILBERT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 PETTUS RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4517
Mailing Address - Country:US
Mailing Address - Phone:615-941-1038
Mailing Address - Fax:
Practice Address - Street 1:2490 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-5508
Practice Address - Country:US
Practice Address - Phone:615-867-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist