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Organization
MERLE PHARMACY NO. 1, INC.
Active
Organization
MERLE PHARMACY NO. 1, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M. MARTIN R.PH. (PRESIDENT)
(309) 828-2242
Entity
Organization
Contact information
Practice address
203 E LOCUST ST, SUITE 1, BLOOMINGTON, IL 61701-3077
(309) 828-2242
(309) 827-4638
Mailing address
203 E LOCUST ST, SUITE 1, BLOOMINGTON, IL 61701-3077
(309) 828-2242
(309) 827-4638
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
054002430
IL
3336C0003X
Community/Retail Pharmacy
Primary
054002430
IL
3336L0003X
Long Term Care Pharmacy
054002430
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032000672
CONTROL DRUG LICENSE NO.
IL
01
—
054002430
STATE PHARMACY LICENSE
IL
01
—
1430925
NABP NUMBER
IL
Enumeration date
03/22/2006
Last updated
07/02/2024
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