MEDICARE: DR. AMY ALEXANDRA MERRILL PHARM D

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	5302034865	MI

General Provider Information

NPI Number	:	1841573045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY ALEXANDRA MERRILL PHARM D

Provider Business Mailing Address
First Line	:	573 S LINCOLN RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-7053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 S MISSION ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-4207
Country	:	US
Telephone Number	:	989-775-8098
Fax Number	:

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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