Provider Demographics
NPI:1811529712
Name:MEKASON PHARMACY BIG SPRING , INC
Entity type:Organization
Organization Name:MEKASON PHARMACY BIG SPRING , INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEMETU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-210-0733
Mailing Address - Street 1:602 E CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:TX
Mailing Address - Zip Code:79745-4427
Mailing Address - Country:US
Mailing Address - Phone:432-586-0116
Mailing Address - Fax:432-586-0117
Practice Address - Street 1:602 E CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:TX
Practice Address - Zip Code:79745-4427
Practice Address - Country:US
Practice Address - Phone:432-586-0116
Practice Address - Fax:432-586-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX691073Medicaid