Provider Demographics
NPI:1427228444
Name:MERTZ, JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MERTZ
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 1:139 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330-1035
Mailing Address - Country:US
Mailing Address - Phone:860-822-1747
Mailing Address - Fax:
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6043
Practice Address - Country:US
Practice Address - Phone:860-886-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist