Healthcare Provider Details

I. General information

NPI: 1407953664
Provider Name (Legal Business Name): DAVID E URBAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE PHARMACY DEPARTMENT
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

121 FARWOOD DR
BALDWINSVILLE NY
13027-3305
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4400
  • Fax:
Mailing address:
  • Phone: 315-635-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: