Provider Demographics
NPI:1194868935
Name:MURPHY, CHARLES LOUIS
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LOUIS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 NORTH MAIN STREET
Mailing Address - Street 2:P.O.BOX 535
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-0535
Mailing Address - Country:US
Mailing Address - Phone:845-651-7878
Mailing Address - Fax:845-651-1300
Practice Address - Street 1:162 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-0535
Practice Address - Country:US
Practice Address - Phone:845-651-7878
Practice Address - Fax:845-651-1300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855014Medicaid
NY3312852OtherNATIONAL NABP NUMBER