MEDICARE: DR. MIGUEL ANDONI RUBIO PHARM.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS41356	FL

General Provider Information

NPI Number	:	1720386923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL ANDONI RUBIO PHARM.D.

Provider Business Mailing Address
First Line	:	740 DUNLAWTON AVE
Second Line	:	ST. 150
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4239
Country	:	US
Telephone Number	:	386-788-8147
Fax Number	:	386-761-7095

Provider Business Practice Location Address
First Line	:	740 DUNLAWTON AVE
Second Line	:	ST. 150
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4239
Country	:	US
Telephone Number	:	386-788-8147
Fax Number	:	386-761-7095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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