Provider Demographics
NPI:1124352331
Name:MERRICK, DIANA SUE (RPH)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:SUE
Last Name:MERRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1231
Mailing Address - Country:US
Mailing Address - Phone:732-251-5214
Mailing Address - Fax:732-251-9425
Practice Address - Street 1:65 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1231
Practice Address - Country:US
Practice Address - Phone:732-251-5214
Practice Address - Fax:732-251-9425
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01598200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist