Provider Demographics
NPI:1861097545
Name:MERRILL, JOSEPH TYSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TYSON
Last Name:MERRILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3625
Mailing Address - Country:US
Mailing Address - Phone:614-491-8137
Mailing Address - Fax:
Practice Address - Street 1:3424 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3625
Practice Address - Country:US
Practice Address - Phone:614-491-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist