Organization
MIDWAY PHARMACY OF CLARKSON INC
Active
Other names
MIDWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR RAY PHARM D (SECRETARY)
(270) 242-2331
Entity
Organization
Contact information
Practice address
627 W MAIN ST, CLARKSON, KY 42726-7044
(270) 242-2331
(844) 608-1625
Mailing address
627 W MAIN ST, CLARKSON, KY 42726-7044
(270) 242-2331
(844) 608-1625
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PO6450
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029385
PK
—
05
—
7100165140
—
KY
Enumeration date
12/23/2005
Last updated
11/29/2016
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