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General NPI Number Information
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NPI Number | 1285025346
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Entity Type | Organization
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Legal Business Name | HODELS-RUBENS PHARMACY
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 1029 S MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61101-1417
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Country | US
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Telephone | 815-968-5779
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 S MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61101-1417
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Country | US
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Telephone | 815-968-5779
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. RUBEN SAMUEL JR.
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Credential |
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Telephone | 815-968-5779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054006670
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License Number State | IL
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