Provider Demographics
NPI:1275735227
Name:MURGA, JODI LYNN
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:MURGA
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 1:2914 149TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-4782
Mailing Address - Country:US
Mailing Address - Phone:309-787-1785
Mailing Address - Fax:
Practice Address - Street 1:107 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4018
Practice Address - Country:US
Practice Address - Phone:309-751-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist