Provider Demographics
NPI:1477681500
Name:MURDOCH DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:MURDOCH DEVELOPMENTAL CENTER
Other - Org Name:MURDOCH DEVELOPMENTAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-575-1285
Mailing Address - Street 1:1600 E C ST
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-2530
Mailing Address - Country:US
Mailing Address - Phone:919-575-1285
Mailing Address - Fax:919-575-1297
Practice Address - Street 1:1600 E C ST
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-2530
Practice Address - Country:US
Practice Address - Phone:919-575-1285
Practice Address - Fax:919-575-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
NC028313336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065392OtherPK
NC346025Medicaid