Provider Demographics
NPI:1679090070
Name:RUBIO COLON, DENNISSE AYLEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:DENNISSE
Middle Name:AYLEEN
Last Name:RUBIO COLON
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 1:30 KETCH CAY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-7511
Mailing Address - Country:US
Mailing Address - Phone:443-540-4768
Mailing Address - Fax:
Practice Address - Street 1:4020 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4225
Practice Address - Country:US
Practice Address - Phone:410-534-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist