Provider Demographics
NPI:1932679685
Name:RUBINO, JUSTIN ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:RUBINO
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 1:14210 ROOSEVELT AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6030
Mailing Address - Country:US
Mailing Address - Phone:347-820-4668
Mailing Address - Fax:
Practice Address - Street 1:14210 ROOSEVELT AVE APT 306
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6030
Practice Address - Country:US
Practice Address - Phone:347-820-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist