Provider Demographics
NPI:1629336136
Name:URBACH, MATTHEW S (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:URBACH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 US RTE. 5
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 WATERFRONT PLZ
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4877
Practice Address - Country:US
Practice Address - Phone:802-334-2313
Practice Address - Fax:802-334-1671
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT76544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist