Provider Demographics
NPI:1891089751
Name:MERRILL, KAREN (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MERRILL
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 1:530 RANDALL RD
Mailing Address - Street 2:T-1896
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3315
Mailing Address - Country:US
Mailing Address - Phone:847-697-1056
Mailing Address - Fax:847-697-1056
Practice Address - Street 1:530 RANDALL RD
Practice Address - Street 2:T-1896
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3315
Practice Address - Country:US
Practice Address - Phone:847-697-1056
Practice Address - Fax:847-697-1056
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist