Healthcare Provider Details

I. General information

NPI: 1003363557
Provider Name (Legal Business Name): DAVID ANDREW MERRELL PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL STE 600
SIERRA VISTA AZ
85635-2973
US

IV. Provider business mailing address

155 CALLE PORTAL STE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-8678
  • Fax:
Mailing address:
  • Phone: 520-515-8673
  • Fax: 520-515-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: