Healthcare Provider Details

I. General information

NPI: 1811804552
Provider Name (Legal Business Name): MESAVET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 HIGHWAY 64
KIRTLAND NM
87417-9415
US

IV. Provider business mailing address

4225 HIGHWAY 64
KIRTLAND NM
87417-9415
US

V. Phone/Fax

Practice location:
  • Phone: 505-516-5499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASPEN THOMPSON
Title or Position: PIC/OWNER
Credential: PHARMD
Phone: 505-516-5499