Healthcare Provider Details

I. General information

NPI: 1104420728
Provider Name (Legal Business Name): RICHARD MARK URBANSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 WEST 26TH STREET
ERIE PA
16508
US

IV. Provider business mailing address

3736 DOMINIC DR
ERIE PA
16506-6030
US

V. Phone/Fax

Practice location:
  • Phone: 814-461-1215
  • Fax: 814-461-7777
Mailing address:
  • Phone: 814-835-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036847L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: