Provider Demographics
NPI:1114271780
Name:MURPHY, JORDAN T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:T
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ARDOENE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-3407
Mailing Address - Country:US
Mailing Address - Phone:401-787-6455
Mailing Address - Fax:
Practice Address - Street 1:43 ARDOENE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3407
Practice Address - Country:US
Practice Address - Phone:401-787-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist