Provider Demographics
NPI:1518932623
Name:RUBIN, MARK S (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:RUBIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:163 RUBIN DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2155
Mailing Address - Country:US
Mailing Address - Phone:304-573-8819
Mailing Address - Fax:304-929-6776
Practice Address - Street 1:908 SCARBRO ROAD
Practice Address - Street 2:NEW RIVER HEALTH CENTER PHARMACY
Practice Address - City:SCARBRO
Practice Address - State:WV
Practice Address - Zip Code:25917
Practice Address - Country:US
Practice Address - Phone:304-469-3424
Practice Address - Fax:304-929-6776
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist