Healthcare Provider Details

I. General information

NPI: 1184441958
Provider Name (Legal Business Name): RYAN MARCUS URENA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 KING ST
CHAPPAQUA NY
10514-3543
US

IV. Provider business mailing address

18 NORTHRIDGE RD
CORTLANDT MANOR NY
10567-6702
US

V. Phone/Fax

Practice location:
  • Phone: 914-861-9130
  • Fax:
Mailing address:
  • Phone: 718-915-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: