Provider Demographics
NPI:1831794775
Name:MERRILL-ELLEBRACHT, MARTHA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:MERRILL-ELLEBRACHT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8867 LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2045
Mailing Address - Country:US
Mailing Address - Phone:314-725-3264
Mailing Address - Fax:314-725-8534
Practice Address - Street 1:8867 LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2045
Practice Address - Country:US
Practice Address - Phone:314-725-3264
Practice Address - Fax:314-725-8534
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020027160OtherBOARD OF PHARMACY