MEDICARE: URS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2175182	OTHER		PK

General Provider Information

NPI Number	:	1336656412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URS PHARMACY

Provider Business Mailing Address
First Line	:	19115 COLIMA RD UNIT 107
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3074
Country	:	US
Telephone Number	:	626-986-5273
Fax Number	:	844-553-7077

Provider Business Practice Location Address
First Line	:	19115 COLIMA RD STE 107
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3003
Country	:	US
Telephone Number	:	626-986-5273
Fax Number	:	844-553-7077

Authorized Official
Title or Position	:	CEO
Name	:	JOHN YU
Credential	:
Telephone Number	:	305-393-0525

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	12/09/2019

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