Provider Demographics
NPI:1518275601
Name:KUBISSA, COLBY DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:DAVID
Last Name:KUBISSA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7307
Mailing Address - Country:US
Mailing Address - Phone:919-855-5694
Mailing Address - Fax:
Practice Address - Street 1:3500 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7307
Practice Address - Country:US
Practice Address - Phone:919-855-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist