Provider Demographics
NPI:1407016355
Name:URBANSKI, VINCENT R
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:R
Last Name:URBANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 EBBTIDE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2920
Mailing Address - Country:US
Mailing Address - Phone:410-676-7620
Mailing Address - Fax:410-322-2071
Practice Address - Street 1:1520 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2815
Practice Address - Country:US
Practice Address - Phone:410-836-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist