Midland Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29611 Issued in TX

Legal business name

MIDLAND PHARMACY, LLC

Practice address

3510 N. Midkiff Rd Ste 100
Midland, TX 79705-4834

Phone

(432) 697-7500

Fax

(432) 697-7507

NPI assigned

Jun 17, 2005

Organization subpart

No

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

Authorized official

Name

Srinivasa Talla

Title

Managing Member

Phone

(845) 392-8254

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• MEDICAL CENTER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Medical Center Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Midland Pharmacy , LLC

  • Community/Retail Pharmacy
  • Midland, TX
  • NPI 1427450956
  NPD tax ID

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lora McCullough, PHARMD

  • Pharmacist
  • Victoria, TX
  • NPI 1760824221
  NPD
• Diana Kay Mosley

  • Pharmacist
  • Midland, TX
  • NPI 1114515731
  NPD
• Jordan Lester, PHARM.D.

  • Pharmacist
  • Midland, TX
  • NPI 1508389123
  NPD (past)
• Steven Ray Rogers, R.PH.

  • Pharmacist
  • Midland, TX
  • NPI 1972574150
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1609871441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 N. MIDKIFF RD STE 100",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797054834",
            "telephone_number": "432-697-7500",
            "fax_number": "432-697-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 N. MIDKIFF RD STE 100",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797054834",
            "telephone_number": "432-697-7500",
            "fax_number": "432-697-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "TALLA",
        "authorized_official_first_name": "SRINIVASA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "845-392-8254"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "29611",
            "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": "2149025",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICAL CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Midland Orthopedic Specialists Group
• Midland Park Mall Dental Practice, P.C.
• Midland Pathologists, PA
• Midland Pediatric Association, PLLC
• Midland Pharmacy , LLC
• Midland Physical Therapy and Sports Rehabilitation Inc
• Midland Plastic Surgery Center PA
• Midland Primary Care
• Midland SCC, LLC
• Midland Speech Center LLC

• Community/Retail Pharmacy in Midland, TX
• Providers in Midland, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; 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.