Healthcare Provider Details

I. General information

NPI: 1245328863
Provider Name (Legal Business Name): MIMI F. MUPHY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

11059 W 72ND ST
INDIAN HEAD PARK IL
60525-5324
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.287369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: