Provider Demographics
NPI:1326646217
Name:JUBIE, ANNA ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:JUBIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1342
Mailing Address - Country:US
Mailing Address - Phone:608-328-4939
Mailing Address - Fax:608-328-4941
Practice Address - Street 1:300 6TH AVE W
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1342
Practice Address - Country:US
Practice Address - Phone:608-328-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13121-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist