Individual
DR. FANTASIA SHEANELL WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
5093 HARDY ST, HATTIESBURG, MS 39402-1336
(601) 579-6698
Mailing address
5093 HARDY ST, HATTIESBURG, MS 39402-1336
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P13650
MS
Other
Enumeration date
09/28/2014
Last updated
09/28/2014
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