Provider Demographics
NPI:1205815123
Name:MURDOCH, CLEBURNE LLOYD (RPH)
Entity type:Individual
Prefix:MR
First Name:CLEBURNE
Middle Name:LLOYD
Last Name:MURDOCH
Suffix:
Gender:M
Credentials:RPH
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 9038
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9038
Mailing Address - Country:US
Mailing Address - Phone:940-569-5333
Mailing Address - Fax:940-569-5360
Practice Address - Street 1:HWY 70 S
Practice Address - Street 2:
Practice Address - City:ROTAN
Practice Address - State:TX
Practice Address - Zip Code:79546
Practice Address - Country:US
Practice Address - Phone:325-735-2500
Practice Address - Fax:325-735-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17968183500000X
TX04945332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141693Medicaid
0828230001Medicare PIN
TX0828230001Medicare NSC