Organization
MICHAEL D MERRILL
Active
Other names
MIKES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MERRILL RPH (OWNER)
(208) 525-8700
Entity
Organization
Contact information
Practice address
180 S HOLMES AVE, IDAHO FALLS, ID 83401-3945
(208) 525-8700
(208) 525-8636
Mailing address
180 S HOLMES AVE, IDAHO FALLS, ID 83401-3945
(208) 525-8700
(208) 525-8636
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
703RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002583900
—
ID
01
—
2020589
PK
—
Enumeration date
03/01/2007
Last updated
11/10/2016
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