Organization
MIDWAY PHARMACY OF CLARKSON INC
Active
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
Update your record
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