Mermaid Walking Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31942 Issued in TX

Legal business name

MERMAID WALKING INC

Doing business as

Divine Pharmacy #2

Practice address

409 State Hwy 495
San Juan, TX 78596

Phone

(956) 601-0140

Fax

(956) 601-0130

NPI assigned

Apr 10, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jose Alberto Vela, PHARM.D.

Title

President

Phone

(956) 583-2700

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Divine Pharmacy #2 Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Idana Merrick, R.PH.

  • Pharmacist
  • Ingleside, TX
  • NPI 1427461813
  NPD
• Federico Eusebio Moron, PHARMD

  • Pharmacist
  • Mission, TX
  • NPI 1932300332
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1487151007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 PAMELA DR STE B",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785724340",
            "telephone_number": "956-583-2700",
            "fax_number": "956-583-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 STATE HWY 495",
            "city": "SAN JUAN",
            "state": "TX",
            "postal_code": "78596",
            "telephone_number": "956-601-0140",
            "fax_number": "956-601-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERMAID WALKING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "VELA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "956-583-2700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149855",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176877",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Pharmacy #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mejor Vida Adult Day Care, LLC
• Melissa Rivera DDS PA
• Jose Luis Mendez Jr., CONTRACTOR
• Rigo Lee Mendoza
• Mercy Rehab Services, Inc.
• Mermaid Walking Inc
• Vanessa O Meza, COTA
• Mi Hacienda Adult Day Care LLC
• Michelle J Trevino
• Mid-Valley Behavioral Health and Psychological Services

• Community/Retail Pharmacy in San Juan, TX
• Providers in San Juan, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.