=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659432474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERIDIAN PHARMACY GROUP NW HIGHWAY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 E PLEASANT RUN RD STE 405
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-333-1600
-----------------------------------------------------
Fax | 214-333-1609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1341 W MOCKINGBIRD LN STE 500
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75247-6913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-951-0133
-----------------------------------------------------
Fax | 214-951-0155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | PAMELA ASHU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-765-9238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 23157
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------