Provider Demographics
NPI:1821021643
Name:URBEN, LEAH AVIS (RPH)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:AVIS
Last Name:URBEN
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 1:5100 DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4491
Mailing Address - Country:US
Mailing Address - Phone:770-419-6006
Mailing Address - Fax:
Practice Address - Street 1:5100 DALLAS HWY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4491
Practice Address - Country:US
Practice Address - Phone:770-419-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist