Provider Demographics
NPI:1326151952
Name:RUBIN, MARK JAY (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3407
Mailing Address - Country:US
Mailing Address - Phone:561-756-3257
Mailing Address - Fax:561-620-4999
Practice Address - Street 1:7040 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3407
Practice Address - Country:US
Practice Address - Phone:561-756-3257
Practice Address - Fax:561-620-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist