# PROVIDERX OF MIDLAND LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** ProvideRx of Midland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093870719
- **Authorized official:** TERRY ALLARD (GENERAL MANAGER)
- **Authorized official phone:** (817) 797-4181

## Contact information

- **Practice address:** 2208 N LOOP 250 W, STE 101, MIDLAND, TX 79707-6011
- **Practice address phone:** (432) 689-3355
- **Practice address fax:** (432) 699-6071
- **Mailing address:** PO BOX 878, GRAPEVINE, TX 76099-0878
- **Mailing address phone:** (817) 778-8767
- **Mailing address fax:** (866) 377-8125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 26842 | TX | Yes |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 07/02/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4534358 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |