Healthcare Provider Details

I. General information

NPI: 1629336136
Provider Name (Legal Business Name): MATTHEW S URBACH PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 WATERFRONT PLZ
NEWPORT VT
05855-4877
US

IV. Provider business mailing address

4408 US RTE. 5
DERBY VT
05829
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-2313
  • Fax: 802-334-1671
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76544
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: