Midway Pharmacy of Clarkson, Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

PO6776 Issued in KY

Legal business name

MIDWAY PHARMACY OF CLARKSON, INC

Doing business as

Midway Pharmacy

Practice address

408 East Maple Street
Caneyville, KY 42721

Phone

(270) 879-6355

Fax

(270) 879-6143

NPI assigned

Dec 23, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Trevor Ray, PHARMD

Title

R.PH./Secretary

Phone

(270) 879-6355

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Midway Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

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

• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Leitchfield, KY
  • NPI 1215914866

  1153440425

  Same PAC ID
• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Clarkson, KY
  • NPI 1700863495

  1153440425

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

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

• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Leitchfield, KY
  • NPI 1215914866

  O20200630002142

  Same enrollment
• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Clarkson, KY
  • NPI 1700863495

  O20200630002142

  Same enrollment
• Midway Pharmacy of Clarkson Inc

  dba Midway Phamacy

  • Community/Retail Pharmacy
  • Henderson, KY
  • NPI 1750895090

  O20200630002142

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

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.

• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Leitchfield, KY
  • NPI 1215914866
  NPD tax ID
• Midway Pharmacy of Clarkson Inc

  dba Midway Pharmacy

  • Community/Retail Pharmacy
  • Clarkson, KY
  • NPI 1700863495
  NPD tax ID
• Midway Pharmacy of Clarkson, Inc

  dba Midway Pharmacy

  • Long Term Care Pharmacy
  • Leitchfield, KY
  • NPI 1467219055
  NPD tax ID

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1467439083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "CANEYVILLE",
            "state": "KY",
            "postal_code": "427210607",
            "telephone_number": "270-879-6355",
            "fax_number": "270-879-6143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 EAST MAPLE STREET",
            "city": "CANEYVILLE",
            "state": "KY",
            "postal_code": "42721",
            "telephone_number": "270-879-6355",
            "fax_number": "270-879-6143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY PHARMACY OF CLARKSON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "R.PH./SECRETARY",
        "authorized_official_telephone_number": "270-879-6355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "PO6776",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KY",
            "license": "PO6776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP ID NUMBER",
            "identifier": "1827558",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100165550",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midway Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Embry Medical Supply
• Embry Welding Supply Inc (Embry Medical Supply)
• Andrea H. Gay, APRN
• Grayson County Hospital Foundation Inc (Twin Lakes Rural Health Clinic at Caneyville)
• Robert E McClure, MD
• Owensboro Health Twin Lakes Regional Medical Center, Inc (Owensboro Health Twin Lakes Medical Center Family Medicine)
• Mike J Utley, D.M.D.

• Pharmacy in Caneyville, KY
• Providers in Caneyville, KY by specialty
• Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.