Provider Demographics
NPI:1144356650
Name:MERRILL CORPORATION
Entity type:Organization
Organization Name:MERRILL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:574-255-1835
Mailing Address - Street 1:610 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6620
Mailing Address - Country:US
Mailing Address - Phone:574-255-1835
Mailing Address - Fax:574-968-0108
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6620
Practice Address - Country:US
Practice Address - Phone:574-255-1835
Practice Address - Fax:574-968-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN600060423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1561403OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN100090500AMedicaid
1561403OtherNCPDP PROVIDER IDENTIFICATION NUMBER