NPIMap

Organization Active NPI

Midway Pharmacy of Clarkson Inc

  • Community/Retail Pharmacy
  • Leitchfield, KY
National Provider Identifier
1215914866
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PO6582 Issued in KY
Legal business name
MIDWAY PHARMACY OF CLARKSON INC
Practice address
1085 William Thomason Byway
Leitchfield, KY 42754-1479
Phone
(270) 259-8400
Fax
(844) 607-4498
NPI assigned
Dec 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Trevor Ray, PHARM D
Title
Secretary
Phone
(270) 259-8400

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PO6582 KY Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1085 William Thomason Byway
Leitchfield, KY 42754-1479

Mailing address

1085 William Thomason Byway
Leitchfield, KY 42754-1479
Phone (270) 259-8400

Other identifiers 2

IdentifierTypeStateIssuer
2033412OtherPK
7100165120MedicaidKY

Other names 1

  • MIDWAY PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200630002142 KY Part B Supplier - Pharmacy 1153440425 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caneyville, KY; Clarkson, KY; Leitchfield, KY
O20200710003100 KY DME Supplier - Pharmacy 1153440425 Practice locations: Leitchfield, KY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Midway Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

408 E Maple St
Caneyville, KY 42721
Phone (270) 879-6355

1085 William Thomason Byu
Leitchfield, KY 42754
Phone (270) 259-8400

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1215914866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 WILLIAM THOMASON BYWAY",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541479",
            "telephone_number": "270-259-8400",
            "fax_number": "844-607-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 WILLIAM THOMASON BYWAY",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541479",
            "telephone_number": "270-259-8400",
            "fax_number": "844-607-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY PHARMACY OF CLARKSON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-26",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "270-259-8400",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "PO6582",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2033412",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100165120",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDWAY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leitchfield, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.