Organization
MP SOUTHPARK PHARMACY LLC
Active
Other names
Myers Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH PRATT PHARMD (OWNER)
(806) 548-0590
Entity
Organization
Contact information
Practice address
29 S CHADB0URNE, SAN ANGELO, TX 76903-5891
(325) 655-3146
(325) 658-5891
Mailing address
29 S CHADB0URNE, SAN ANGELO, TX 76903-5891
(325) 655-3146
(325) 658-5891
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
31522
TX
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31522
PHARMACY LICENSE
TX
Enumeration date
07/10/2006
Last updated
09/12/2025
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