MEDICARE: MERRILL LYNN MARCHETTI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5367	TN

General Provider Information

NPI Number	:	1700185923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRILL LYNN MARCHETTI RPH

Provider Business Mailing Address
First Line	:	2600 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3925
Country	:	US
Telephone Number	:	615-382-9844
Fax Number	:	615-212-0758

Provider Business Practice Location Address
First Line	:	2600 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3925
Country	:	US
Telephone Number	:	615-382-9844
Fax Number	:	615-212-0758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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