Provider Demographics
NPI:1124628235
Name:OLIVEIRA, RUBEN
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 OAKLYN ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2540
Mailing Address - Country:US
Mailing Address - Phone:321-557-4266
Mailing Address - Fax:
Practice Address - Street 1:1001 E EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4907
Practice Address - Country:US
Practice Address - Phone:321-773-0663
Practice Address - Fax:321-773-7589
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist