# PECOS STREET PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi-Mart Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659374379
- **Authorized official:** BRYAN T ABERNATHY (PRESIDENT)
- **Authorized official phone:** (325) 949-4636

## Contact information

- **Practice address:** 2102 PECOS ST, STE 13, SAN ANGELO, TX 76901-3061
- **Practice address phone:** (325) 949-5381
- **Practice address fax:** (325) 942-9997
- **Mailing address:** 2102 PECOS ST, SAN ANGELO, TX 76901-3061
- **Mailing address phone:** (325) 949-5381
- **Mailing address fax:** (325) 942-9997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 13819 | TX | — |
| 3336L0003X | Long Term Care Pharmacy | 13819 | TX | Yes |

## Other

- **Enumeration date:** 05/27/2005
- **Last updated:** 07/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 350004 | — | TX |
| 01 | — | 4586307 | NABP NUMBER | TX |