Healthcare Provider Details

I. General information

NPI: 1356899306
Provider Name (Legal Business Name): MARIANNE MERKEL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S VISITING EAGLE ST
NIOBRARA NE
68760-7201
US

IV. Provider business mailing address

110 S VISITING EAGLE ST
NIOBRARA NE
68760-7201
US

V. Phone/Fax

Practice location:
  • Phone: 402-857-2901
  • Fax: 402-857-2911
Mailing address:
  • Phone: 402-857-2901
  • Fax: 402-857-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9655
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4334
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: