=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811529712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEKASON PHARMACY BIG SPRING , INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2020
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 E CAMPBELL ST
-----------------------------------------------------
City | KERMIT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79745-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-586-0116
-----------------------------------------------------
Fax | 432-586-0117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 E CAMPBELL ST
-----------------------------------------------------
City | KERMIT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79745-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-586-0116
-----------------------------------------------------
Fax | 432-586-0117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | EMEKA ONYEMETU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 432-210-0733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------