Provider Demographics
NPI:1295847101
Name:NORVAL D. MEREDITH
Entity Type:Organization
Organization Name:NORVAL D. MEREDITH
Other - Org Name:KEEL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NORVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:325-365-3505
Mailing Address - Street 1:706 HUTCHINS AVE
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-5609
Mailing Address - Country:US
Mailing Address - Phone:325-365-3505
Mailing Address - Fax:325-365-5376
Practice Address - Street 1:706 HUTCHINS AVE
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-5609
Practice Address - Country:US
Practice Address - Phone:325-365-3505
Practice Address - Fax:325-365-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX061163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142093Medicaid
4513582OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX013712701Medicaid
TX091454101Medicaid
TX091454101Medicaid