Healthcare Provider Details

I. General information

NPI: 1437157559
Provider Name (Legal Business Name): MERICH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 NW CACHE RD
LAWTON OK
73505-2712
US

IV. Provider business mailing address

7210 NW CACHE RD
LAWTON OK
73505-2712
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-1133
  • Fax: 580-536-5945
Mailing address:
  • Phone: 580-536-1133
  • Fax: 580-536-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3-4619
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD CLEMMER
Title or Position: OWNER AND PHARM
Credential: RPH
Phone: 580-536-1133