Organization
MIDWAY PHARMACY OF CLARKSON INC
Active
Other names
Midway Phamacy, Midway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR RAY (SECRETARY/OWNER)
(270) 212-1001
Entity
Organization
Contact information
Practice address
1640 2ND ST, HENDERSON, KY 42420-3364
(270) 212-1001
(855) 782-5261
Mailing address
408 E MAPLE ST, PO BOX 607, CANEYVILLE, KY 42721-9059
(270) 212-1001
(855) 782-5261
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07865
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2174033
PK
—
05
—
7100504950
—
KY
Enumeration date
11/22/2017
Last updated
04/19/2018
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