Healthcare Provider Details

I. General information

NPI: 1487355863
Provider Name (Legal Business Name): MAYA SUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 LIMESTONE RD
WILMINGTON DE
19808-1928
US

IV. Provider business mailing address

1225 MADISON LN
HOCKESSIN DE
19707-9418
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-2286
  • Fax:
Mailing address:
  • Phone: 614-767-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30072088
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: