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NPI Code Detail

MEDICARE: MIDWESTERN COMPOUNDING PHARMACY LLC

MEDICARE: MIDWESTERN COMPOUNDING PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy02-114560002136OH
23336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1457891830
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWESTERN COMPOUNDING PHARMACY LLC
Provider Business Mailing Address
First Line : PO BOX 126
Second Line :
City : PLAIN CITY
State : OH
Zip : 43064-0126
Country : US
Telephone Number : 614-573-1557
Fax Number : 614-300-7558
Provider Business Practice Location Address
First Line : 203 N CHILLICOTHE ST
Second Line :
City : PLAIN CITY
State : OH
Zip : 43064-1045
Country : US
Telephone Number : 614-733-3784
Fax Number : 614-721-7996
Authorized Official
Title or Position : MANAGING MEMBER
Name : LONNIE JOE CRAFT
Credential : RPH
Telephone Number : 614-573-1557
Provider Enumeration Date : 03/03/2017
Last Update Date : 08/08/2025

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Directions to “MIDWESTERN COMPOUNDING PHARMACY LLC ” Practice Location

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