Healthcare Provider Details

I. General information

NPI: 1316113186
Provider Name (Legal Business Name): MAXIM RUBENCHIK PHARM.D., R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 02/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST METHODIST HOSPITAL PHARMACY DEPT.
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST METHODIST HOSPITAL PHARMACY DEPT.
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5575
  • Fax:
Mailing address:
  • Phone: 718-780-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: