Provider Demographics
NPI:1609158690
Name:URBAN, MICHELLE OTTEY (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:OTTEY
Last Name:URBAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13500 NC 50/210
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445
Mailing Address - Country:US
Mailing Address - Phone:910-329-1134
Mailing Address - Fax:910-329-1175
Practice Address - Street 1:13500 NC HIGHWAY 50 # 210
Practice Address - Street 2:SUITE 101
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-7934
Practice Address - Country:US
Practice Address - Phone:910-329-1134
Practice Address - Fax:910-329-1175
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist