PECOS STREET PHARMACY INC. NPI 1659374379

NPI Information

  • NPI: 1659374379
  • Provider Name: PECOS STREET PHARMACY, INC.
  • Classification: Pharmacy - 3336L0003X
  • Specialization: Long Term Care Pharmacy
  • Entity Type: Organization
  • Doing Business As: MEDI-MART PHARMACY
  • CLIA Number: 45D2153699
  • Address: 2102 PECOS ST
    STE 13
    SAN ANGELO, TX
    ZIP 76901
  • Phone: (325) 949-5381

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NPI Details

PECOS STREET PHARMACY, INC. is a long term care pharmacy pharmacy in San Angelo, TX. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. PECOS STREET PHARMACY, INC. NPI is 1659374379. The provider is registered as an organization entity type.
The provider Is Doing Business As Medi-mart Pharmacy.

The provider's business location address is:

2102 PECOS ST
STE 13
SAN ANGELO, TX
ZIP 76901-061
Phone: (325) 949-5381
Fax: (325) 942-9997

The provider's authorized official is Bryan T Abernathy .
The authorized official title is President and has the following contact phone number (325) 949-4636.

The CLIA number assigned to this NPI record is 45D2153699 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/27/2005 and was last updated on 7/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy13819TEXASNo
23336L0003XPharmacyLong Term Care Pharmacy13819TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14586307OTHERTEXASNABP NUMBER
2350004MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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