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General NPI Number Information
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NPI Number | 1295729895
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Entity Type | Individual
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Provider Name | ROBERT B KUBASAK R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 403 CLEVELAND ST
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City | ELYRIA
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State | OH
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Zip | 44035-6143
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Country | US
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Telephone | 440-366-9670
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Fax | 440-365-7891
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Provider Business Mailing Address
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Address Line | 37580 EAGLE NEST DR
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City | GRAFTON
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State | OH
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Zip | 44044-9790
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Country | US
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Telephone | 440-366-9670
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Fax | 440-365-7891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-3-10545
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License Number State | OH
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