Provider Demographics
NPI:1194305979
Name:MURDAY, DEBRA ANN
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:MURDAY
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 1:309 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1113
Mailing Address - Country:US
Mailing Address - Phone:989-652-2613
Mailing Address - Fax:989-652-4420
Practice Address - Street 1:309 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1113
Practice Address - Country:US
Practice Address - Phone:989-652-2613
Practice Address - Fax:989-652-4420
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301003123333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy