Provider Demographics
NPI:1144503954
Name:HILBURN, VAN LE (PHARMD, MBA)
Entity type:Individual
Prefix:MRS
First Name:VAN
Middle Name:LE
Last Name:HILBURN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 HEALTH SCIENCES DR # 845
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-1503
Mailing Address - Country:US
Mailing Address - Phone:858-822-6094
Mailing Address - Fax:
Practice Address - Street 1:3855 HEALTH SCIENCES DR # 845
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:858-822-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61355OtherCALIFORNIA BOARD OF PHARMACY