# MERLE PHARMACY NO. 1, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407815061
- **Authorized official:** MR. WILLIAM M. MARTIN R.PH. (PRESIDENT)
- **Authorized official phone:** (309) 828-2242

## Contact information

- **Practice address:** 203 E LOCUST ST, SUITE 1, BLOOMINGTON, IL 61701-3077
- **Practice address phone:** (309) 828-2242
- **Practice address fax:** (309) 827-4638
- **Mailing address:** 203 E LOCUST ST, SUITE 1, BLOOMINGTON, IL 61701-3077
- **Mailing address phone:** (309) 828-2242
- **Mailing address fax:** (309) 827-4638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 054002430 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | 054002430 | IL | Yes |
| 3336L0003X | Long Term Care Pharmacy | 054002430 | IL | — |

## Other

- **Enumeration date:** 03/22/2006
- **Last updated:** 07/02/2024

## 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 |