Provider Demographics
NPI:1750805636
Name:HUBERS, DYLAN SHANE
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:SHANE
Last Name:HUBERS
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 1:633 NC 33 E
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-9005
Mailing Address - Country:US
Mailing Address - Phone:252-946-4000
Mailing Address - Fax:252-946-4000
Practice Address - Street 1:633 NC 33 E
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-9005
Practice Address - Country:US
Practice Address - Phone:252-946-4000
Practice Address - Fax:252-946-4000
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist