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Organization
PROVIDERX OF MIDLAND LLC
Active
Organization
PROVIDERX OF MIDLAND LLC
Active
Other names
ProvideRx of Midland
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY ALLARD (GENERAL MANAGER)
(817) 797-4181
Entity
Organization
Contact information
Practice address
2208 N LOOP 250 W, STE 101, MIDLAND, TX 79707-6011
(432) 689-3355
(432) 699-6071
Mailing address
PO BOX 878, GRAPEVINE, TX 76099-0878
(817) 778-8767
(866) 377-8125
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
26842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4534358
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/22/2006
Last updated
07/02/2010
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