Healthcare Provider Details

I. General information

NPI: 1477471241
Provider Name (Legal Business Name): ST.MEENA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OSLER BLVD
BRYAN TX
77802-2516
US

IV. Provider business mailing address

2601 OSLER BLVD
BRYAN TX
77802-2516
US

V. Phone/Fax

Practice location:
  • Phone: 979-485-9123
  • Fax: 979-485-9124
Mailing address:
  • Phone: 979-485-9123
  • Fax: 979-485-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAIKEL GADELSAYED
Title or Position: PIC
Credential:
Phone: 201-888-7265