Provider Demographics
NPI:1598186199
Name:PRO K, INC
Entity Type:Organization
Organization Name:PRO K, INC
Other - Org Name:PRIMEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-595-1300
Mailing Address - Street 1:1387 GEORGE DIETER
Mailing Address - Street 2:STE A-104
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-595-1300
Mailing Address - Fax:915-595-1303
Practice Address - Street 1:1387 GEORGE DIETER
Practice Address - Street 2:SUITE A-104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1803
Practice Address - Country:US
Practice Address - Phone:915-595-1300
Practice Address - Fax:915-595-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143592OtherPK