Provider Demographics
NPI:1376195610
Name:RUBESICH, MICHAEL NICHOLAS JR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:RUBESICH
Suffix:JR
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 1:14564 LEFFINGWELL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44401-9630
Mailing Address - Country:US
Mailing Address - Phone:330-651-1880
Mailing Address - Fax:
Practice Address - Street 1:713 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420
Practice Address - Country:US
Practice Address - Phone:330-545-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3-03-22049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist