Medi-Mart Pharmacy

LBN: Pecos Street Pharmacy, Inc.
Medi-Mart Pharmacy is an health care organization with primary practice located at 2102 Pecos St Ste 13, San Angelo TX 76901-3061. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Long Term Care Pharmacy is the primary health care specialty. Pecos Street Pharmacy, Inc. can be contacted via phone (325) 949-5381, or through Abernathy, Bryan T via phone (325) 949-4636.

Contact Information

Primary practice address
2102 Pecos St Ste 13 San Angelo TX 76901-3061
Phone: (325) 949-5381
Fax: (325) 942-9997
Website:
Map and Directions
Authorized official contact:
Name: Abernathy, Bryan T
Phone: (325) 949-4636

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 13819 Texas
Suppliers / Long Term Care Pharmacy 3336L0003X 13819 Texas

Profile Details

NPI number 1659374379
LBN Legal business name Pecos Street Pharmacy, Inc.
DBA Doing business as Medi-Mart Pharmacy
Authorized official Abernathy, Bryan T
Entity Organization
Organization subpart 1 No
Enumeration date May 27th, 2005
Last updated Jul 11th, 2019 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659374379 NPPES
Texas MEDICAID 350004
Texas Other 4586307

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