Healthcare Provider Details

I. General information

NPI: 1740564517
Provider Name (Legal Business Name): MELINDA RUBLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 07/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 DESIARD ST
MONROE LA
71203-4936
US

IV. Provider business mailing address

7920 DESIARD ST
MONROE LA
71203-4936
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-1284
  • Fax:
Mailing address:
  • Phone: 318-343-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294415
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.019383
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2010031681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: