Provider Demographics
NPI:1174542310
Name:HEFLIN, WILBUR LEE
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:LEE
Last Name:HEFLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22734-9693
Mailing Address - Country:US
Mailing Address - Phone:540-439-8456
Mailing Address - Fax:540-439-9822
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734-9693
Practice Address - Country:US
Practice Address - Phone:540-439-8456
Practice Address - Fax:540-439-9822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202001580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist