Provider Demographics
NPI:1790069011
Name:SUBA, RICHARD T (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:T
Last Name:SUBA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4105
Mailing Address - Country:US
Mailing Address - Phone:941-755-8526
Mailing Address - Fax:941-756-3757
Practice Address - Street 1:6003 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4105
Practice Address - Country:US
Practice Address - Phone:941-755-8526
Practice Address - Fax:941-756-3757
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist