Provider Demographics
NPI:1598244329
Name:MERRICK WELLNESS INC
Entity Type:Organization
Organization Name:MERRICK WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUGANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-525-1500
Mailing Address - Street 1:12614 MERRICK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3431
Mailing Address - Country:US
Mailing Address - Phone:718-525-1500
Mailing Address - Fax:718-525-1505
Practice Address - Street 1:12614 MERRICK BLVD STE F
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3431
Practice Address - Country:US
Practice Address - Phone:718-525-1500
Practice Address - Fax:718-525-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy