Provider Demographics
NPI:1578820981
Name:NUBILA, RICHARD GANA (PHARM D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GANA
Last Name:NUBILA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 COLUMBIA PIKE
Mailing Address - Street 2:APT C8
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-681-7342
Mailing Address - Fax:
Practice Address - Street 1:6224 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4217
Practice Address - Country:US
Practice Address - Phone:703-538-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20463183500000X
VA0202211213183500000X
DCPH100001341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist