Healthcare Provider Details

I. General information

NPI: 1689611592
Provider Name (Legal Business Name): MICHAEL JAMES URBANEC PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 BERKSHIRE DR
BISMARCK ND
58503-7898
US

IV. Provider business mailing address

2519 BERKSHIRE DR
BISMARCK ND
58503-7898
US

V. Phone/Fax

Practice location:
  • Phone: 701-224-5105
  • Fax:
Mailing address:
  • Phone: 701-224-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4988
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: