Active NPI
Fantasia Sheanell Wilburn, PHARMD
- Pharmacist
- Hattiesburg, MS
National Provider Identifier
1063815686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P13650
- Practice address
- 5093 Hardy St
Hattiesburg, MS 39402-1336 - Phone
- (601) 579-6698
- NPI assigned
- Sep 28, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P13650 | MS | Primary |
Addresses
Primary practice location
5093 Hardy St
Hattiesburg, MS 39402-1336
Mailing address
5093 Hardy St
Hattiesburg, MS 39402-1336
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P13650 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Hattiesburg, MS
- NPI 1558376715
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411862400000",
"number": "1063815686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5093 HARDY ST",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394021336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5093 HARDY ST",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394021336",
"telephone_number": "601-579-6698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBURN",
"first_name": "FANTASIA",
"middle_name": "SHEANELL",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-28",
"last_updated": "2014-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "P13650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.