Provider Demographics
NPI:1205909785
Name:MURRAY, MIKE R (PD)
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:R
Last Name:MURRAY
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EDISON
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-5361
Mailing Address - Country:US
Mailing Address - Phone:501-776-2013
Mailing Address - Fax:501-776-0451
Practice Address - Street 1:500 EDISON
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-5361
Practice Address - Country:US
Practice Address - Phone:501-776-2013
Practice Address - Fax:501-776-0451
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114910407Medicaid