Healthcare Provider Details

I. General information

NPI: 1821681537
Provider Name (Legal Business Name): RENA RHEASHAE RUBIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-7101
US

IV. Provider business mailing address

11717 PRADO RANCH BLVD
AUSTIN TX
78725-6302
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-8984
  • Fax:
Mailing address:
  • Phone: 832-581-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number250656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: