Provider Demographics
NPI:1639446560
Name:WILBERT, JUNITHA CANNON
Entity Type:Individual
Prefix:
First Name:JUNITHA
Middle Name:CANNON
Last Name:WILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 COTSWOLD LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4542
Mailing Address - Country:US
Mailing Address - Phone:901-737-0712
Mailing Address - Fax:
Practice Address - Street 1:5128 COTSWOLD LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4542
Practice Address - Country:US
Practice Address - Phone:901-737-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist