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1053080010 NPI number — KELLON DEVIN MEIGHOO PHARMACIST INTERN

NPI Number: 1053080010
Health Care Provider/Practitioner: KELLON DEVIN MEIGHOO PHARMACIST INTERN

Information about “1053080010” NPI (KELLON DEVIN MEIGHOO PHARMACIST INTERN) exists in 1053080010 in HTML format HTML  |  1053080010 in plain Text format TXT  |  1053080010 in PDF (Portable Document Format) PDF  |  1053080010 in an XML format XML  formats.

NPI Number : 1053080010 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053080010",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MEIGHOO",
    "FirstName": "KELLON",
    "MiddleName": "DEVIN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMACIST INTERN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10902 DOVE PARK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77075-4666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "832-573-7215",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9828 BLACKHAWK BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77075-2246",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-991-3762",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2021",
    "LastUpdateDate": "09/16/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183700000X",
          "TaxonomyName": "Pharmacy Technician",
          "LicenseNumber": "187365",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "71341",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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