Provider Demographics
NPI:1588917124
Name:RUBLE, RICHARD ALAN (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:RUBLE
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 1:1758 UPPER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-9726
Mailing Address - Country:US
Mailing Address - Phone:970-946-2969
Mailing Address - Fax:
Practice Address - Street 1:1758 UPPER RIVER RD
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525-9726
Practice Address - Country:US
Practice Address - Phone:970-946-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0006837183500000X
OHRPH.03110834-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist