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Contact Information

MIDWAY PHARMACY OF CLARKSON, INC
408 EAST MAPLE STREET
CANEYVILLE, KY42721
 Phone: 270-879-6355
 Fax: 270-879-6143
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for MIDWAY PHARMACY OF CLARKSON, INC

NPI # 1467439083
LBN Legal business name MIDWAY PHARMACY OF CLARKSON, INC
Authorized official TREVOR RAY - (R.PH./SECRETARY)
Entity Organization
Organization subpart 1 No
Enumeration date 12/23/2005
Last updated 03/07/2023 - About 3 years ago
Identifiers
KY License # PO6776
KY Medicaid 7100165550
KY Other 1827558 NCPDP ID NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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