Provider Demographics
NPI:1497152813
Name:MESHESHA, FREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:FREW
Middle Name:
Last Name:MESHESHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 HUECO VALLEY DR APT 907
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5417
Mailing Address - Country:US
Mailing Address - Phone:206-359-1448
Mailing Address - Fax:
Practice Address - Street 1:3700 HUECO VALLEY DR APT 907
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5417
Practice Address - Country:US
Practice Address - Phone:206-359-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55863183500000X
NMRP00008288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist