Healthcare Provider Details

I. General information

NPI: 1629195789
Provider Name (Legal Business Name): URX5 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GROVE ST
WATERBURY CT
06710-2289
US

IV. Provider business mailing address

185 GROVE ST
WATERBURY CT
06710-2289
US

V. Phone/Fax

Practice location:
  • Phone: 203-575-0199
  • Fax: 203-575-0515
Mailing address:
  • Phone: 203-575-0199
  • Fax: 203-575-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0001330
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPCY.0001330
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN BUTURLA
Title or Position: PRESIDENT
Credential:
Phone: 203-824-3570