Provider Demographics
NPI:1619491776
Name:URBAN, BREANNE DARLENE (PHARMD)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:DARLENE
Last Name:URBAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4633
Mailing Address - Country:US
Mailing Address - Phone:585-485-6459
Mailing Address - Fax:585-485-6460
Practice Address - Street 1:3122 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4633
Practice Address - Country:US
Practice Address - Phone:585-485-6459
Practice Address - Fax:585-485-6460
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist