Provider Demographics
NPI:1972128874
Name:ST.MEENA PLLC
Entity Type:Organization
Organization Name:ST.MEENA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GADELSAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-888-7265
Mailing Address - Street 1:4900 WILLIAMS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4174
Mailing Address - Country:US
Mailing Address - Phone:201-888-7265
Mailing Address - Fax:
Practice Address - Street 1:2601 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2516
Practice Address - Country:US
Practice Address - Phone:201-888-7265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy