Healthcare Provider Details

I. General information

NPI: 1851611081
Provider Name (Legal Business Name): OKIE LEE DUBOSE JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HIGHLAND SPRINGS AVE
BANNING CA
92220-6504
US

IV. Provider business mailing address

16872 OLYMPIC CT
FONTANA CA
92336-5153
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-1285
  • Fax: 951-769-1594
Mailing address:
  • Phone: 909-350-0033
  • Fax: 951-769-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: