Healthcare Provider Details

I. General information

NPI: 1144556838
Provider Name (Legal Business Name): JANET CHARLES BUBIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN A 62
DALLAS TX
75230-2505
US

IV. Provider business mailing address

7777 FOREST LN A-62
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-661-0835
  • Fax: 972-661-3176
Mailing address:
  • Phone: 972-661-0835
  • Fax: 972-661-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: