1639614290 NPI number — DR. CLINTON ROBERT MURCHLAND PHARMD

Table of content: DR. CLINTON ROBERT MURCHLAND PHARMD (NPI 1639614290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639614290 NPI number — DR. CLINTON ROBERT MURCHLAND PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURCHLAND
Provider First Name:
CLINTON
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639614290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
828 FOX POINT PLAZA
Provider Second Line Business Mailing Address:
PHARMACY
Provider Business Mailing Address City Name:
NEENAH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-722-1348
Provider Business Mailing Address Fax Number:
920-722-1624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 FOX POINT PLAZA
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
NEENAH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-722-1348
Provider Business Practice Location Address Fax Number:
920-722-1624
Provider Enumeration Date:
01/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18048-40 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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