Provider Demographics
NPI:1235306580
Name:URBAN INDEPENDENT PHARMACY
Entity Type:Organization
Organization Name:URBAN INDEPENDENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-864-1110
Mailing Address - Street 1:7525 MILITARY PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-3950
Mailing Address - Country:US
Mailing Address - Phone:214-275-5900
Mailing Address - Fax:214-275-5906
Practice Address - Street 1:7525 MILITARY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-3950
Practice Address - Country:US
Practice Address - Phone:214-275-5900
Practice Address - Fax:214-275-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145924Medicaid