Organization
MIDLAND PHARMACY, LLC
Active
Other names
MEDICAL CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASA TALLA (MANAGING MEMBER)
(845) 392-8254
Entity
Organization
Contact information
Practice address
3510 N. MIDKIFF RD STE 100, MIDLAND, TX 79705-4834
(432) 697-7500
(432) 697-7507
Mailing address
3510 N. MIDKIFF RD STE 100, MIDLAND, TX 79705-4834
(432) 697-7500
(432) 697-7507
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29611
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149025
PK
—
Enumeration date
06/17/2005
Last updated
08/24/2021
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