Healthcare Provider Details

I. General information

NPI: 1295847101
Provider Name (Legal Business Name): NORVAL D. MEREDITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HUTCHINS AVE
BALLINGER TX
76821-5609
US

IV. Provider business mailing address

706 HUTCHINS AVE
BALLINGER TX
76821-5609
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-3505
  • Fax: 325-365-5376
Mailing address:
  • Phone: 325-365-3505
  • Fax: 325-365-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number06116
License Number StateTX

VIII. Authorized Official

Name: NORVAL MEREDITH
Title or Position: OWNER PHARMACIST
Credential: PHARMACY
Phone: 325-365-3505