Healthcare Provider Details

I. General information

NPI: 1104428325
Provider Name (Legal Business Name): LAURA BETH URBANSKI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 MIDTOWN RD
PERU IL
61354-1267
US

IV. Provider business mailing address

65 BROOK VIEW DR
LA SALLE IL
61301-9669
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-4276
  • Fax: 815-223-4957
Mailing address:
  • Phone: 815-228-7641
  • Fax: 815-223-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051288037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: