Provider Demographics
NPI:1295729895
Name:KUBASAK, ROBERT B (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:KUBASAK
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 1:37580 EAGLE NEST DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9790
Mailing Address - Country:US
Mailing Address - Phone:440-366-9670
Mailing Address - Fax:440-365-7891
Practice Address - Street 1:403 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6143
Practice Address - Country:US
Practice Address - Phone:440-366-9670
Practice Address - Fax:440-365-7891
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-10545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-3-10545OtherPHARMACIST LICENSE