Healthcare Provider Details

I. General information

NPI: 1306488853
Provider Name (Legal Business Name): URBANA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 WORTHINGTON BLVD STE B
FREDERICK MD
21704-7020
US

IV. Provider business mailing address

3420 WORTHINGTON BLVD STE B
FREDERICK MD
21704-7020
US

V. Phone/Fax

Practice location:
  • Phone: 240-831-5155
  • Fax: 301-810-2940
Mailing address:
  • Phone: 240-831-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ADETOLA DARAMOLA
Title or Position: OWNER AND PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 240-604-6770