Provider Demographics
NPI:1639562325
Name:DUPOTEY-RUBI, INDIRA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:S
Last Name:DUPOTEY-RUBI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3724
Mailing Address - Country:US
Mailing Address - Phone:786-546-0672
Mailing Address - Fax:
Practice Address - Street 1:3741 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3724
Practice Address - Country:US
Practice Address - Phone:786-546-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49399183500000X
ORRPH0013750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist