Provider Demographics
NPI:1477975381
Name:DUBAY, KEN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:DUBAY
Suffix:JR
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 1:51200 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1563
Mailing Address - Country:US
Mailing Address - Phone:586-716-3187
Mailing Address - Fax:586-716-3204
Practice Address - Street 1:51200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1563
Practice Address - Country:US
Practice Address - Phone:586-716-3187
Practice Address - Fax:586-716-3204
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist