Provider Demographics
NPI:1669640520
Name:MURRAY, DAVID JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:MURRAY
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 1:4 JACOB ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9518
Mailing Address - Country:US
Mailing Address - Phone:518-399-6819
Mailing Address - Fax:
Practice Address - Street 1:3031 ROUTE 50
Practice Address - Street 2:TARGET-1271
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2926
Practice Address - Country:US
Practice Address - Phone:518-226-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61990044Medicaid