Provider Demographics
NPI:1942977699
Name:PAUL, MERLIN
Entity Type:Individual
Prefix:MRS
First Name:MERLIN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SONG SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9148
Mailing Address - Country:US
Mailing Address - Phone:754-802-9667
Mailing Address - Fax:
Practice Address - Street 1:4568 US HIGHWAY 220 N
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9412
Practice Address - Country:US
Practice Address - Phone:336-644-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62121183500000X
VA0202219092183500000X
NC31062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist