Provider Demographics
NPI:1053080010
Name:MEIGHOO, KELLON DEVIN (PHARMACIST INTERN)
Entity Type:Individual
Prefix:
First Name:KELLON
Middle Name:DEVIN
Last Name:MEIGHOO
Suffix:
Gender:M
Credentials:PHARMACIST INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10902 DOVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4666
Mailing Address - Country:US
Mailing Address - Phone:832-573-7215
Mailing Address - Fax:
Practice Address - Street 1:9828 BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2246
Practice Address - Country:US
Practice Address - Phone:713-991-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187365183700000X
TX71341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician