Healthcare Provider Details

I. General information

NPI: 1235445867
Provider Name (Legal Business Name): JOSEPH JOHN URBAN III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BUSTLETON AVE
PHILADELPHIA PA
19116-2516
US

IV. Provider business mailing address

11750 BUSTLETON AVE
PHILADELPHIA PA
19116-2516
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-3171
  • Fax: 215-677-2773
Mailing address:
  • Phone: 215-464-3171
  • Fax: 215-677-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042986L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: