Provider Demographics
NPI:1427689306
Name:RUBINO, GASPARE (RPH)
Entity type:Individual
Prefix:MR
First Name:GASPARE
Middle Name:
Last Name:RUBINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-4286
Mailing Address - Country:US
Mailing Address - Phone:586-914-7073
Mailing Address - Fax:
Practice Address - Street 1:50980 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-4626
Practice Address - Country:US
Practice Address - Phone:586-949-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist