Healthcare Provider Details

I. General information

NPI: 1811434137
Provider Name (Legal Business Name): URVISH ITALIA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18050 CLOUDS REST RD
SOULSBYVILLE CA
95372-9788
US

IV. Provider business mailing address

18050 CLOUDS REST RD
SOULSBYVILLE CA
95372-9788
US

V. Phone/Fax

Practice location:
  • Phone: 909-248-4619
  • Fax:
Mailing address:
  • Phone: 909-248-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: