Provider Demographics
NPI:1952738395
Name:MEJIA, NOE (PHARMD)
Entity type:Individual
Prefix:
First Name:NOE
Middle Name:
Last Name:MEJIA
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 1:1121 BOLING LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4851
Mailing Address - Country:US
Mailing Address - Phone:575-642-2063
Mailing Address - Fax:
Practice Address - Street 1:1256 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6026
Practice Address - Country:US
Practice Address - Phone:575-525-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006509183500000X
TX48142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist