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General NPI Number Information
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NPI Number | 1720688757
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Entity Type | Individual
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Provider Name | GEORGE OTTO MERRILL JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 200 MARKET PL
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City | RICHLAND
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State | MS
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Zip | 39218-4429
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Country | US
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Telephone | 601-939-2958
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Fax | 601-939-4489
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Provider Business Mailing Address
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Address Line | 640 WENDOVER WAY
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City | RIDGELAND
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State | MS
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Zip | 39157-4193
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Country | US
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Telephone | 601-668-6055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-08224
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License Number State | MS
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