Healthcare Provider Details

I. General information

NPI: 1760048755
Provider Name (Legal Business Name): RUBICON DTP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 W 73RD ST # A
INDIANAPOLIS IN
46278-1741
US

IV. Provider business mailing address

5751 W 73RD ST # A
INDIANAPOLIS IN
46278-1741
US

V. Phone/Fax

Practice location:
  • Phone: 317-524-1515
  • Fax: 888-833-7928
Mailing address:
  • Phone: 317-552-1100
  • Fax: 317-552-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID E BURAND
Title or Position: PRESIDENT
Credential: RPH
Phone: 317-552-1100