Provider Demographics
NPI:1114526308
Name:MERK-BENN, REBECCA JAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JAYNE
Last Name:MERK-BENN
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 1:4114 SONDAY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST JUNCTION
Mailing Address - State:WI
Mailing Address - Zip Code:54407-9590
Mailing Address - Country:US
Mailing Address - Phone:715-630-0062
Mailing Address - Fax:715-345-2698
Practice Address - Street 1:250 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-4124
Practice Address - Country:US
Practice Address - Phone:715-345-7870
Practice Address - Fax:715-345-2698
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12542-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist