Provider Demographics
NPI:1992027916
Name:MURDICK, JODY LYNN
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:MURDICK
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 1:1179 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7363
Mailing Address - Country:US
Mailing Address - Phone:810-989-7610
Mailing Address - Fax:810-982-8400
Practice Address - Street 1:1179 32ND ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7363
Practice Address - Country:US
Practice Address - Phone:810-989-7610
Practice Address - Fax:810-982-8400
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist