Provider Demographics
NPI:1215335443
Name:MEKAGREEN INC
Entity type:Organization
Organization Name:MEKAGREEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:EMEKA
Authorized Official - Last Name:IKEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:323-643-4240
Mailing Address - Street 1:1373 W 29TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3195
Mailing Address - Country:US
Mailing Address - Phone:323-643-4240
Mailing Address - Fax:323-643-4209
Practice Address - Street 1:1373 W 29TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3195
Practice Address - Country:US
Practice Address - Phone:323-643-4240
Practice Address - Fax:323-643-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215335443Medicaid