Provider Demographics
NPI:1437740297
Name:MERRILL, CRAIG LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:LEE
Last Name:MERRILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E MICHIGAN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9823
Mailing Address - Country:US
Mailing Address - Phone:866-964-2638
Mailing Address - Fax:
Practice Address - Street 1:135 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-7914
Practice Address - Country:US
Practice Address - Phone:734-547-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist