# MIDWAY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Midway Market Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164795431
- **Authorized official:** DANIEL COOK PHARMD (PHARMACY MANAGER/PIC)
- **Authorized official phone:** (435) 657-0170

## Contact information

- **Practice address:** 42 W MAIN ST, MIDWAY, UT 84049-6313
- **Practice address phone:** (435) 654-1926
- **Practice address fax:** (435) 654-3039
- **Mailing address:** PO BOX 26417, SALT LAKE CITY, UT 84126-0417
- **Mailing address phone:** (435) 654-1926
- **Mailing address fax:** (435) 654-3039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8208474-1703 | UT | Yes |

## Other

- **Enumeration date:** 02/17/2012
- **Last updated:** 03/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164795431 | — | UT |
| 01 | — | 4612190 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |