=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780121558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JUDY GURGANUS MURPHY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2017
-----------------------------------------------------
Last Update Date | 01/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 NC HIGHWAY 53 E
-----------------------------------------------------
City | BURGAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28425-4585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-789-6006
-----------------------------------------------------
Fax | 910-789-6007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 NC HIGHWAY 53 E
-----------------------------------------------------
City | BURGAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28425-4585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-789-6006
-----------------------------------------------------
Fax | 910-789-6007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 7028
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------