Healthcare Provider Details

I. General information

NPI: 1114388576
Provider Name (Legal Business Name): MICHAEL RUBINSKY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LENOLA RD
MAPLE SHADE NJ
08052-3435
US

IV. Provider business mailing address

300 S LENOLA RD
MAPLE SHADE NJ
08052-3435
US

V. Phone/Fax

Practice location:
  • Phone: 856-778-1049
  • Fax: 856-778-4529
Mailing address:
  • Phone: 856-778-1049
  • Fax: 856-778-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02278000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RJ01688
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: