Healthcare Provider Details

I. General information

NPI: 1740440510
Provider Name (Legal Business Name): ERIC DANIEL URBANOWSKI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 09/26/2020
Certification Date: 09/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W FIRST ST
MANTENO IL
60950-1239
US

IV. Provider business mailing address

47 S LOCUST ST
MANTENO IL
60950-1515
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-0036
  • Fax: 630-852-6545
Mailing address:
  • Phone: 815-468-0190
  • Fax: 815-468-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051290462
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: