Provider Demographics
NPI:1366965469
Name:WIDHALM MURPHY, SANDRA CHRISTINE (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:WIDHALM MURPHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2917
Mailing Address - Country:US
Mailing Address - Phone:507-401-8482
Mailing Address - Fax:507-401-8483
Practice Address - Street 1:600 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2917
Practice Address - Country:US
Practice Address - Phone:507-401-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1168921835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care