Provider Demographics
NPI:1386923951
Name:MERRICK, ANDREW JAMES
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MERRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 NEW KENT HWY
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1735
Mailing Address - Country:US
Mailing Address - Phone:804-932-4336
Mailing Address - Fax:804-932-8963
Practice Address - Street 1:2587 NEW KENT HWY
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1735
Practice Address - Country:US
Practice Address - Phone:804-932-4336
Practice Address - Fax:804-932-8963
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist