Provider Demographics
NPI:1659583508
Name:MERTZ, DARREN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:M
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 1:912 S PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2249
Mailing Address - Country:US
Mailing Address - Phone:253-345-4669
Mailing Address - Fax:253-590-0211
Practice Address - Street 1:702 BROADWAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3735
Practice Address - Country:US
Practice Address - Phone:253-495-2740
Practice Address - Fax:253-590-0211
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039768183500000X
AZ11281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00039768OtherPHARMACIST LICENCE NUMBER