Healthcare Provider Details

I. General information

NPI: 1023302585
Provider Name (Legal Business Name): GREGORY URBAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6791 CASTLE RDG
HAMBURG NY
14075-6438
US

IV. Provider business mailing address

6791 CASTLE RDG
HAMBURG NY
14075-6438
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-6383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: