# MIDWAY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942210059
- **Authorized official:** LILLIAM DOMINGUEZ RPH (PHARMACIST)
- **Authorized official phone:** (787) 873-1480

## Contact information

- **Practice address:** BO MAGINAS 225 C MARGINAL, SABANA GRANDE, PR 00637
- **Practice address phone:** (787) 873-1480
- **Practice address fax:** (787) 804-1480
- **Mailing address:** BO MAGINA 22S C/MARGINA/STE 2, SABANA GRANDE, PR 00637

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 07F2067 | PR | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 02/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4023937 | OTHER ID NUMBER | — |