Provider Demographics
NPI:1790230803
Name:MURPHY, MAXMILLIAN EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAXMILLIAN
Middle Name:EDWARD
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 1:255 NW COMMONS LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-7700
Mailing Address - Country:US
Mailing Address - Phone:386-719-5451
Mailing Address - Fax:386-719-5456
Practice Address - Street 1:255 NW COMMONS LOOP
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-7700
Practice Address - Country:US
Practice Address - Phone:386-719-5451
Practice Address - Fax:386-719-5456
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist