Provider Demographics
NPI:1477868040
Name:RUBIN, HARVEY P (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:P
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 1:3361 S SHORE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1773
Mailing Address - Country:US
Mailing Address - Phone:734-717-4020
Mailing Address - Fax:248-626-0466
Practice Address - Street 1:3361 S SHORE CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1773
Practice Address - Country:US
Practice Address - Phone:734-717-4020
Practice Address - Fax:248-626-0466
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist