Provider Demographics
NPI:1992172076
Name:MURRAY, SUSAN (DPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BIRD ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-9569
Mailing Address - Country:US
Mailing Address - Phone:580-622-2144
Mailing Address - Fax:580-622-6486
Practice Address - Street 1:1900 BIRD ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-9569
Practice Address - Country:US
Practice Address - Phone:580-622-2144
Practice Address - Fax:580-622-6486
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist