Provider Demographics
NPI:1104428325
Name:URBANSKI, LAURA BETH (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:URBANSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BROOK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-9669
Mailing Address - Country:US
Mailing Address - Phone:815-228-7641
Mailing Address - Fax:815-223-4957
Practice Address - Street 1:1651 MIDTOWN RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1267
Practice Address - Country:US
Practice Address - Phone:815-223-4276
Practice Address - Fax:815-223-4957
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist