Provider Demographics
NPI:1285989079
Name:MERRICK, CRAIG (RPH)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MERRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E DONALD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-2920
Mailing Address - Country:US
Mailing Address - Phone:574-231-8416
Mailing Address - Fax:
Practice Address - Street 1:901 E DONALD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2920
Practice Address - Country:US
Practice Address - Phone:574-231-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013362A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist