Provider Demographics
NPI:1578742466
Name:URBAN CLINIC PHARMACY INC
Entity Type:Organization
Organization Name:URBAN CLINIC PHARMACY INC
Other - Org Name:URBAN CLINIC PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-443-6483
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-0033
Mailing Address - Country:US
Mailing Address - Phone:402-443-1630
Mailing Address - Fax:402-443-1631
Practice Address - Street 1:1760 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4152
Practice Address - Country:US
Practice Address - Phone:402-443-1630
Practice Address - Fax:402-443-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27923336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055964OtherPK