Provider Demographics
NPI:1063620417
Name:MURR, RODDY J (RPH)
Entity type:Individual
Prefix:
First Name:RODDY
Middle Name:J
Last Name:MURR
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 1:717 NATION DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3507
Mailing Address - Country:US
Mailing Address - Phone:817-444-2838
Mailing Address - Fax:
Practice Address - Street 1:161 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3117
Practice Address - Country:US
Practice Address - Phone:817-444-1377
Practice Address - Fax:817-444-3438
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist