Provider Demographics
NPI:1649549312
Name:RUBIO PHARMACY AND DISCOUNT INC
Entity type:Organization
Organization Name:RUBIO PHARMACY AND DISCOUNT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LERYCKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:305-405-3333
Mailing Address - Street 1:18600 NW 87TH AVE UNIT 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3528
Mailing Address - Country:US
Mailing Address - Phone:305-405-3333
Mailing Address - Fax:305-405-3334
Practice Address - Street 1:18600 NW 87TH AVE UNIT 109
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3528
Practice Address - Country:US
Practice Address - Phone:305-405-3333
Practice Address - Fax:305-405-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH258573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133224OtherPK
FL004794000Medicaid