Provider Demographics
NPI:1902142979
Name:URBANSKI, JAN MALLEY
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MALLEY
Last Name:URBANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WIMBEE CIR
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7026
Mailing Address - Country:US
Mailing Address - Phone:843-645-1888
Mailing Address - Fax:
Practice Address - Street 1:163 SEA ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1504
Practice Address - Country:US
Practice Address - Phone:843-986-9658
Practice Address - Fax:843-986-0607
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132381835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy