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
—
—
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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