MEDICARE: RUBICON DTP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336L0003X	Long Term Care Pharmacy
2	3336M0002X	Mail Order Pharmacy
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1569776	OTHER	NCPDP
2	1407877467	OTHER	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174091557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBICON DTP, LLC

Provider Business Mailing Address
First Line	:	5175 W 73RD STREET
Second Line	:	B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278
Country	:	US
Telephone Number	:	833-200-2010
Fax Number	:	317-552-1101

Provider Business Practice Location Address
First Line	:	5751 W 73RD ST # A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1741
Country	:	US
Telephone Number	:	317-524-1515
Fax Number	:	844-325-7228

Authorized Official
Title or Position	:	PRESIDENT- PIC
Name	:	DAVID BURAND
Credential	:	RPH
Telephone Number	:	317-552-1100

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/27/2023

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Directions to “RUBICON DTP, LLC ” Practice Location

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