Organization
MIDLAND PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FT COUTS (OWNER)
(374) 429-7703
Entity
Organization
Contact information
Practice address
9628 MIDLAND BLVD, OVERLAND, MO 63114-3353
(314) 423-2000
Mailing address
9628 MIDLAND BLVD, OVERLAND, MO 63114-3353
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
003480
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2609191
OTHER ID NUMBER
—
Enumeration date
04/25/2007
Last updated
09/12/2007
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