Provider Demographics
NPI:1538773171
Name:MERRITT, ANNETTE (RPH)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1212 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2834
Mailing Address - Country:US
Mailing Address - Phone:417-673-5623
Mailing Address - Fax:417-673-5409
Practice Address - Street 1:1212 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2834
Practice Address - Country:US
Practice Address - Phone:417-673-5623
Practice Address - Fax:417-673-5409
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist