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General NPI Number Information
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NPI Number | 1407815061
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Entity Type | Organization
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Legal Business Name | MERLE PHARMACY NO. 1, INC.
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 203 E LOCUST ST SUITE 1
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3077
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Country | US
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Telephone | 309-828-2242
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Fax | 309-827-4638
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Provider Business Mailing Address
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Address Line | 203 E LOCUST ST SUITE 1
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3077
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Country | US
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Telephone | 309-828-2242
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Fax | 309-827-4638
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM M. MARTIN
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Credential | R.PH.
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Telephone | 309-828-2242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054002430
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 054002430
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054002430
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License Number State | IL
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