MEDICARE: THAD MURRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	3534	SC

General Provider Information

NPI Number	:	1063678464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAD MURRAY

Provider Business Mailing Address
First Line	:	877 REGATTA RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4934
Country	:	US
Telephone Number	:	843-795-3667
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 RIVERS AVE
Second Line	:	SUITE 2
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405
Country	:	US
Telephone Number	:	843-745-8636
Fax Number	:	843-747-6841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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