Provider Demographics
NPI:1538564604
Name:QUAN, WILBUR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILBUR
Middle Name:
Last Name:QUAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-2638
Mailing Address - Country:US
Mailing Address - Phone:909-984-4387
Mailing Address - Fax:909-984-6552
Practice Address - Street 1:1670 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2638
Practice Address - Country:US
Practice Address - Phone:909-984-4387
Practice Address - Fax:909-984-6552
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist