Provider Demographics
NPI:1902382088
Name:RUBIN, MELISA DYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:DYAN
Last Name:RUBIN
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 1:8316 WYCOMBE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3038
Mailing Address - Country:US
Mailing Address - Phone:919-610-9000
Mailing Address - Fax:
Practice Address - Street 1:2340 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-7528
Practice Address - Country:US
Practice Address - Phone:919-790-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist