Provider Demographics
NPI:1043882459
Name:KROM, MERZ
Entity Type:Individual
Prefix:
First Name:MERZ
Middle Name:
Last Name:KROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 N 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5111
Mailing Address - Country:US
Mailing Address - Phone:480-489-0435
Mailing Address - Fax:
Practice Address - Street 1:1654 N PEBBLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2571
Practice Address - Country:US
Practice Address - Phone:623-207-6808
Practice Address - Fax:623-207-6814
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist