Provider Demographics
NPI:1912286204
Name:RUBIO, ANDREA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:RUBIO
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:PO BOX 1767
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1767
Mailing Address - Country:US
Mailing Address - Phone:808-573-8345
Mailing Address - Fax:
Practice Address - Street 1:540 HALEAKALA HWY
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2302
Practice Address - Country:US
Practice Address - Phone:808-871-8755
Practice Address - Fax:808-871-8723
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH816183500000X
CARPH30968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist