Provider Demographics
NPI:1265031082
Name:MECHELAY, EDITH (RPH)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:MECHELAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2917
Mailing Address - Country:US
Mailing Address - Phone:806-662-5601
Mailing Address - Fax:
Practice Address - Street 1:2801 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2824
Practice Address - Country:US
Practice Address - Phone:806-669-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist