Provider Demographics
NPI:1790394427
Name:MEKASON PHARMACY ODESSA, INC
Entity Type:Organization
Organization Name:MEKASON PHARMACY ODESSA, INC
Other - Org Name:ANDREWS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEMETU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-210-0733
Mailing Address - Street 1:1312 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3660
Mailing Address - Country:US
Mailing Address - Phone:432-223-2265
Mailing Address - Fax:432-223-2266
Practice Address - Street 1:1312 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3660
Practice Address - Country:US
Practice Address - Phone:432-223-2265
Practice Address - Fax:432-223-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX691099Medicaid