Provider Demographics
NPI:1174602510
Name:LUBINA, PHILLIP OTTO (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:OTTO
Last Name:LUBINA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 JUDSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8501
Mailing Address - Country:US
Mailing Address - Phone:925-550-6412
Mailing Address - Fax:
Practice Address - Street 1:1951 HOLMES ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6015
Practice Address - Country:US
Practice Address - Phone:925-447-7762
Practice Address - Fax:925-447-4375
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1945183500000X
NV9014183500000X
CA395541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist