Organization
MIDWAY PHARMACY OF CLARKSON, INC
Active
Other names
Midway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREVOR RAY PHARMD (R.PH./SECRETARY)
(270) 879-6355
Entity
Organization
Contact information
Practice address
408 EAST MAPLE STREET, CANEYVILLE, KY 42721
(270) 879-6355
(270) 879-6143
Mailing address
PO BOX 607, CANEYVILLE, KY 42721-0607
(270) 879-6355
(270) 879-6143
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO6776
KY
333600000X
Pharmacy
Primary
PO6776
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1827558
NCPDP ID NUMBER
KY
05
—
7100165550
—
KY
Enumeration date
12/23/2005
Last updated
03/07/2023
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