Healthcare Provider Details

I. General information

NPI: 1053371260
Provider Name (Legal Business Name): REBEKAH JEAN DUBE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 VERANDA ST
PORTLAND ME
04104-5040
US

IV. Provider business mailing address

1 WILLOW AVE
OLD ORCHARD BEACH ME
04064-1522
US

V. Phone/Fax

Practice location:
  • Phone: 207-791-3743
  • Fax: 207-828-2494
Mailing address:
  • Phone: 207-934-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5034
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1954
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: