Provider Demographics
NPI:1720386923
Name:RUBIO, MIGUEL ANDONI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANDONI
Last Name:RUBIO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 DUNLAWTON AVE
Mailing Address - Street 2:ST. 150
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4239
Mailing Address - Country:US
Mailing Address - Phone:386-788-8147
Mailing Address - Fax:386-761-7095
Practice Address - Street 1:740 DUNLAWTON AVE
Practice Address - Street 2:ST. 150
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4239
Practice Address - Country:US
Practice Address - Phone:386-788-8147
Practice Address - Fax:386-761-7095
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist