=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619974268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MURRAY-OVERHILL PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 W STATE ST
-----------------------------------------------------
City | MEDIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19063-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-566-2345
-----------------------------------------------------
Fax | 610-565-0837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 W STATE ST
-----------------------------------------------------
City | MEDIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19063-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-566-2345
-----------------------------------------------------
Fax | 610-565-0837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | V.P. OPRNS
-----------------------------------------------------
Name | MR. MARTIN RONALD BRIAN
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 610-566-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PP411657L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------