Provider Demographics
NPI:1649507450
Name:MERRITT, JACQUELINE SUE (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:SUE
Other - Last Name:VITELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:511 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1881
Mailing Address - Country:US
Mailing Address - Phone:919-363-1471
Mailing Address - Fax:919-363-6140
Practice Address - Street 1:511 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1881
Practice Address - Country:US
Practice Address - Phone:919-363-1471
Practice Address - Fax:919-363-6140
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist