Provider Demographics
NPI:1225360563
Name:RUBIN, LEONARD
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33400 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4909
Mailing Address - Country:US
Mailing Address - Phone:248-474-8813
Mailing Address - Fax:248-474-9703
Practice Address - Street 1:33400 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4909
Practice Address - Country:US
Practice Address - Phone:248-474-8813
Practice Address - Fax:248-474-9703
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist