Provider Demographics
NPI:1659984888
Name:CULVERHOUSE, MERRILL
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:
Last Name:CULVERHOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7330
Mailing Address - Country:US
Mailing Address - Phone:334-335-5888
Mailing Address - Fax:334-335-4713
Practice Address - Street 1:1440 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7330
Practice Address - Country:US
Practice Address - Phone:334-335-5888
Practice Address - Fax:334-335-4713
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist