Provider Demographics
NPI:1487795944
Name:MURPHY040, MARK JOSEPH
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:MURPHY040
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:100 VANDERPOEL AVE .
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-0045
Mailing Address - Country:US
Mailing Address - Phone:860-567-4726
Mailing Address - Fax:
Practice Address - Street 1:59 WEST STREET
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759
Practice Address - Country:US
Practice Address - Phone:860-567-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist