Provider Demographics
NPI:1255481974
Name:MERRITT, ANN THERESE (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:THERESE
Last Name:MERRITT
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 1:419 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1506
Mailing Address - Country:US
Mailing Address - Phone:319-465-4906
Mailing Address - Fax:
Practice Address - Street 1:419 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1506
Practice Address - Country:US
Practice Address - Phone:319-465-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist