Provider Demographics
NPI:1649308271
Name:RUEBKE, MARK CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:RUEBKE
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 1:1865 S FORTY DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9646
Mailing Address - Country:US
Mailing Address - Phone:217-328-1789
Mailing Address - Fax:
Practice Address - Street 1:1208 N CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-1801
Practice Address - Country:US
Practice Address - Phone:217-383-8494
Practice Address - Fax:217-344-6737
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist