Provider Demographics
NPI:1609464247
Name:MEBUGE, SMART (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SMART
Middle Name:
Last Name:MEBUGE
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 1:7227 N MESA ST APT 807
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3635
Mailing Address - Country:US
Mailing Address - Phone:347-393-2868
Mailing Address - Fax:
Practice Address - Street 1:5401 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4909
Practice Address - Country:US
Practice Address - Phone:915-779-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist