Basic Information
| Provider Information | |||||||||
| NPI: | 1720001274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIO | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P5 CALLE 1 | ||||||||
| Address2: | URB DOS RIOS | ||||||||
| City: | TOA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009494006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875014384 | ||||||||
| FaxNumber: | 7877846131 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR # 2 KM 7.1 | ||||||||
| Address2: | SANTA ROSA MALL LOCAL 24 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877866306 | ||||||||
| FaxNumber: | 7879667652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2573 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.