Provider Demographics
NPI:1124375886
Name:MCCUBBIN, MONICA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 ED BLUESTEIN BLVD
Mailing Address - Street 2:HEB PHARMACY
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2900
Mailing Address - Country:US
Mailing Address - Phone:512-926-0586
Mailing Address - Fax:
Practice Address - Street 1:7112 ED BLUESTEIN BLVD
Practice Address - Street 2:HEB PHARMACY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2900
Practice Address - Country:US
Practice Address - Phone:512-926-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49407OtherTEXAS STATE BOARD OF PHARMACY LICENSE