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General NPI Number Information
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NPI Number | 1760048755
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Entity Type | Organization
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Legal Business Name | RUBICON DTP, LLC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5751 W 73RD ST # A
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1741
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Country | US
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Telephone | 317-524-1515
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Fax | 888-833-7928
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Provider Business Mailing Address
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Address Line | 5751 W 73RD ST # A
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1741
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Country | US
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Telephone | 317-552-1100
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Fax | 317-552-1101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID E BURAND
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Credential | RPH
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Telephone | 317-552-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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