Provider Demographics
NPI:1104420728
Name:URBANSKI, RICHARD MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:URBANSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6030
Mailing Address - Country:US
Mailing Address - Phone:814-835-0829
Mailing Address - Fax:
Practice Address - Street 1:1635 WEST 26TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-461-1215
Practice Address - Fax:814-461-7777
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036847L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist