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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