Provider Demographics
NPI:1740564517
Name:RUBLE, MELINDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:RUBLE
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 1:7920 DESIARD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4936
Mailing Address - Country:US
Mailing Address - Phone:318-343-1284
Mailing Address - Fax:
Practice Address - Street 1:7920 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4936
Practice Address - Country:US
Practice Address - Phone:318-343-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2015-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294415183500000X
LAPST.019383183500000X
MO2010031681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMA.000573OtherMEDICATION ADMINISTRATION