Provider Demographics
NPI:1679843817
Name:WILBURN, MARKITA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARKITA
Middle Name:A
Last Name:WILBURN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E CARY ST
Mailing Address - Street 2:APT. 4128
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7827
Mailing Address - Country:US
Mailing Address - Phone:412-721-2868
Mailing Address - Fax:
Practice Address - Street 1:9801 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4530
Practice Address - Country:US
Practice Address - Phone:804-264-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist