Provider Demographics
NPI:1811995483
Name:RUBIN, MARC LOUIS (RPH AE-C)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:LOUIS
Last Name:RUBIN
Suffix:
Gender:M
Credentials:RPH AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1987
Mailing Address - Country:US
Mailing Address - Phone:815-356-1986
Mailing Address - Fax:
Practice Address - Street 1:6140 ROUTE 14
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7931
Practice Address - Country:US
Practice Address - Phone:815-356-8767
Practice Address - Fax:815-356-8790
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist