Provider Demographics
NPI:1720350754
Name:RUBINO, TERRI SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:SUE
Last Name:RUBINO
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 1:67 MESA DR
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3093
Mailing Address - Country:US
Mailing Address - Phone:203-393-9669
Mailing Address - Fax:
Practice Address - Street 1:700 BRIDGEPORT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4734
Practice Address - Country:US
Practice Address - Phone:203-265-6336
Practice Address - Fax:203-225-0309
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist