Healthcare Provider Details

I. General information

NPI: 1952738395
Provider Name (Legal Business Name): NOE MEJIA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 EL PASEO RD
LAS CRUCES NM
88001-6026
US

IV. Provider business mailing address

1121 BOLING LN
LAS CRUCES NM
88007-4851
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8713
  • Fax:
Mailing address:
  • Phone: 575-642-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006509
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: