Provider Demographics
NPI:1841597226
Name:MERCHAN, MARIA DE LOURDES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOURDES
Last Name:MERCHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 CLAIBORNE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3719
Mailing Address - Country:US
Mailing Address - Phone:678-480-3687
Mailing Address - Fax:
Practice Address - Street 1:5505 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3901
Practice Address - Country:US
Practice Address - Phone:770-441-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist