Provider Demographics
NPI:1558930305
Name:MERRIMAC PRIMECARE, INC
Entity Type:Organization
Organization Name:MERRIMAC PRIMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHENOUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-603-3559
Mailing Address - Street 1:15340 VANTAGE PKWY E STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-1901
Mailing Address - Country:US
Mailing Address - Phone:410-603-3559
Mailing Address - Fax:
Practice Address - Street 1:15340 VANTAGE PKWY E STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-1901
Practice Address - Country:US
Practice Address - Phone:410-603-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy