Midway Pharmacy of Clarkson Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P07865 Issued in KY

Legal business name

MIDWAY PHARMACY OF CLARKSON INC

Doing business as

Midway Phamacy

Practice address

1640 2ND St
Henderson, KY 42420-3364

Phone

(270) 212-1001

Fax

(855) 782-5261

NPI assigned

Nov 22, 2017

Last updated

Apr 19, 2018By 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

Trevor Ray

Title

Secretary/Owner

Phone

(270) 212-1001

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 2

• Midway Phamacy Doing business as
• Midway Pharmacy Other name

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

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 Pharmacy

  • Pharmacy
  • Caneyville, KY
  • NPI 1467439083

  O20200630002142

  Same enrollment

Locations

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

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1750895090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E MAPLE ST",
            "address_2": "PO BOX 607",
            "city": "CANEYVILLE",
            "state": "KY",
            "postal_code": "427219059",
            "telephone_number": "270-212-1001",
            "fax_number": "855-782-5261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 2ND ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424203364",
            "telephone_number": "270-212-1001",
            "fax_number": "855-782-5261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY PHARMACY OF CLARKSON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-22",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "SECRETARY/OWNER",
        "authorized_official_telephone_number": "270-212-1001"
    },
    "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": "P07865",
            "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": "2174033",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100504950",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midway Phamacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Midway Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Methodist Health, Inc. (Methodist Oncology and Hematology)
• Methodist Health, Inc. (Methodist Pulmonology)
• Methodist Health, Inc. (Methodist Hospital Ambulance Service)
• Methodist Health, Inc. (Deaconess Henderson Emergency)
• Methodist Health, Inc. (Deaconess Family Pharmacy Henderson)
• Maranda Wortham Miles, APRN
• Brooke Miller, PHARMD
• Elizabeth Miller, CCCSLP
• Jeffrey R Miller, MD
• Jason Roberts Millikan, LPCA

• Community/Retail Pharmacy in Henderson, KY
• Providers in Henderson, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.