Provider Demographics
NPI:1609232990
Name:ROBISON, RUEBEN
Entity Type:Individual
Prefix:
First Name:RUEBEN
Middle Name:
Last Name:ROBISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 S COIT RD
Mailing Address - Street 2:UNIT 1207
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3007
Mailing Address - Country:US
Mailing Address - Phone:281-619-0772
Mailing Address - Fax:
Practice Address - Street 1:6905 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-7376
Practice Address - Country:US
Practice Address - Phone:903-454-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist