Provider Demographics
NPI:1275210866
Name:MECHAEL, MENA
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:MECHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BRITTANY ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2368
Mailing Address - Country:US
Mailing Address - Phone:661-308-7941
Mailing Address - Fax:
Practice Address - Street 1:4600 PANAMA LN UNIT 102B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-3511
Practice Address - Country:US
Practice Address - Phone:661-707-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist