Organization
MIDWAY PHARMACY OF CLARKSON INC
Active
Other names
MIDWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR RAY PHRMD (SECRETARY)
(270) 242-4344
Entity
Organization
Contact information
Practice address
9847 ELIZABETHTOWN RD, STE 102, BIG CLIFTY, KY 42712-5880
(270) 242-4344
(844) 607-4506
Mailing address
PO BOX 100, BIG CLIFTY, KY 42712-0100
(270) 242-4344
(844) 607-4506
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07254
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035134
PK
—
05
—
7100165160
—
KY
05
—
7100236160
—
KY
Enumeration date
05/21/2008
Last updated
11/29/2016
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