Healthcare Provider Details

I. General information

NPI: 1306134952
Provider Name (Legal Business Name): URBAN SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 34TH ST S STE A
ST PETERSBURG FL
33711-2855
US

IV. Provider business mailing address

1617 34TH ST S STE A
ST PETERSBURG FL
33711-2855
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-9881
  • Fax: 727-327-9884
Mailing address:
  • Phone: 727-327-9881
  • Fax: 727-327-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25577
License Number StateFL

VIII. Authorized Official

Name: MR. PARESH SHUKLA
Title or Position: OWNER
Credential: R.PH.
Phone: 727-327-9881