Healthcare Provider Details

I. General information

NPI: 1518932623
Provider Name (Legal Business Name): MARK S. RUBIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SCARBRO ROAD NEW RIVER HEALTH CENTER PHARMACY
SCARBRO WV
25917
US

IV. Provider business mailing address

163 RUBIN DR
BECKLEY WV
25801-2155
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-3424
  • Fax: 304-929-6776
Mailing address:
  • Phone: 304-573-8819
  • Fax: 304-929-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0004046
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: