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General NPI Number Information
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NPI Number | 1851611081
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Entity Type | Individual
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Provider Name | OKIE LEE DUBOSE JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 300 S HIGHLAND SPRINGS AVE
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City | BANNING
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State | CA
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Zip | 92220-6504
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Country | US
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Telephone | 951-769-1285
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Fax | 951-769-1594
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Provider Business Mailing Address
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Address Line | 16872 OLYMPIC CT
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City | FONTANA
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State | CA
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Zip | 92336-5153
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Country | US
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Telephone | 909-350-0033
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Fax | 951-769-1594
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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 | 44517
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License Number State | CA
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