Provider Demographics
NPI:1780713883
Name:MURRAY, MARK ANDREW (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97869-0217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 FRONT STR
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:OR
Practice Address - Zip Code:97869-0217
Practice Address - Country:US
Practice Address - Phone:541-820-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist