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Organization
MIDWAY PHARMACY
Active
Organization
MIDWAY PHARMACY
Active
Other names
Midway Market Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL COOK PHARMD (PHARMACY MANAGER/PIC)
(435) 657-0170
Entity
Organization
Contact information
Practice address
42 W MAIN ST, MIDWAY, UT 84049-6313
(435) 654-1926
(435) 654-3039
Mailing address
PO BOX 26417, SALT LAKE CITY, UT 84126-0417
(435) 654-1926
(435) 654-3039
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8208474-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164795431
—
UT
01
—
4612190
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/17/2012
Last updated
03/25/2013
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