Healthcare Provider Details

I. General information

NPI: 1811529712
Provider Name (Legal Business Name): MEKASON PHARMACY BIG SPRING , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E CAMPBELL ST
KERMIT TX
79745-4427
US

IV. Provider business mailing address

602 E CAMPBELL ST
KERMIT TX
79745-4427
US

V. Phone/Fax

Practice location:
  • Phone: 432-586-0116
  • Fax: 432-586-0117
Mailing address:
  • Phone: 432-586-0116
  • Fax: 432-586-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EMEKA ONYEMETU
Title or Position: OFFICER
Credential:
Phone: 432-210-0733