Healthcare Provider Details

I. General information

NPI: 1508188871
Provider Name (Legal Business Name): MARK MERRITT VALLEY R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S GENESSEE ST
BELLAIRE MI
49615-9651
US

IV. Provider business mailing address

6600 M 66 N
CHARLEVOIX MI
49720-9505
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-6307
  • Fax:
Mailing address:
  • Phone: 231-547-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: