Pecos Street Pharmacy, Inc.

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

13819 Issued in TX

Legal business name

PECOS STREET PHARMACY, INC.

Doing business as

Medi-Mart Pharmacy

Practice address

2102 Pecos St
Ste 13
San Angelo, TX 76901-3061

Phone

(325) 949-5381

Fax

(325) 942-9997

NPI assigned

May 27, 2005

Organization subpart

No

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

Authorized official

Name

Bryan T Abernathy

Title

President

Phone

(325) 949-4636

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Medi-Mart Pharmacy Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Williams Eakman, R.PH.

  • Pharmacist
  • San Angelo, TX
  • NPI 1447253398
  NPD (past)

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1659374379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 PECOS ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013061",
            "telephone_number": "325-949-5381",
            "fax_number": "325-942-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 PECOS ST",
            "address_2": "STE 13",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013061",
            "telephone_number": "325-949-5381",
            "fax_number": "325-942-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS STREET PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "ABERNATHY",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "325-949-4636"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "13819",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "13819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350004",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "4586307",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi-Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medi-Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Long Term Care Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.