Healthcare Provider Details

I. General information

NPI: 1891166781
Provider Name (Legal Business Name): DOROTHY URBANK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 10/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SMELTER AVE NE
GREAT FALLS MT
59404-1940
US

IV. Provider business mailing address

152 SUN MEADOWS RD
GREAT FALLS MT
59404-6314
US

V. Phone/Fax

Practice location:
  • Phone: 406-761-1456
  • Fax:
Mailing address:
  • Phone: 406-965-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4700
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: