MEDICARE: CARLOS E URRIOLA R.PH.

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	183500000X	Pharmacist	040101	NY

General Provider Information

NPI Number	:	1437272762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS E URRIOLA R.PH.

Provider Business Mailing Address
First Line	:	172 SPRING ST APT 20
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-3756
Country	:	US
Telephone Number	:	917-420-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2039 SAINT PAUL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3905
Country	:	US
Telephone Number	:	917-929-3380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	01/08/2010

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