MEDICARE: GAIL ANNETTE MERRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	17822	NV

General Provider Information

NPI Number	:	1275818221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL ANNETTE MERRELL

Provider Business Mailing Address
First Line	:	1101 S LAS VEGAS BLV
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-471-6844
Fax Number	:	702-471-6872

Provider Business Practice Location Address
First Line	:	1101 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1305
Country	:	US
Telephone Number	:	702-471-6844
Fax Number	:	702-741-6872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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Directions to “ GAIL ANNETTE MERRELL ” Practice Location

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