Provider Demographics
NPI:1306837224
Name:URBANC, LISA K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:K
Last Name:URBANC
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:W5080 HANBURY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:VULCAN
Mailing Address - State:MI
Mailing Address - Zip Code:49892-8989
Mailing Address - Country:US
Mailing Address - Phone:906-563-7275
Mailing Address - Fax:
Practice Address - Street 1:N16088 US 2-41
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886-0155
Practice Address - Country:US
Practice Address - Phone:906-497-5516
Practice Address - Fax:906-497-4206
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2344757Medicaid
MI540E50255OtherBLUE CROSS
MI2769665Medicaid
MI0735390001Medicare NSC