Provider Demographics
NPI:1154974350
Name:MURCKO, MAUREEN
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MURCKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 DRAKE STATELINE RD NE
Mailing Address - Street 2:
Mailing Address - City:BURGHILL
Mailing Address - State:OH
Mailing Address - Zip Code:44404-9718
Mailing Address - Country:US
Mailing Address - Phone:330-651-1404
Mailing Address - Fax:
Practice Address - Street 1:713 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1750
Practice Address - Country:US
Practice Address - Phone:330-545-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist