Provider Demographics
NPI:1417019233
Name:MURDOCK, JOHNNY A
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:A
Last Name:MURDOCK
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 497
Mailing Address - Street 2:623 N 9TH STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006
Mailing Address - Country:US
Mailing Address - Phone:870-347-3371
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:1740 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:PARKIN
Practice Address - State:AR
Practice Address - Zip Code:72373
Practice Address - Country:US
Practice Address - Phone:870-755-2838
Practice Address - Fax:870-755-2840
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist