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NPI Code Detail

MEDICARE: MIDWAY SPECIALTY CARE RX LLC

MEDICARE: MIDWAY SPECIALTY CARE RX 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
1261QM2500XMedical Specialty Clinic/CenterPH29049FL
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15726750OTHERNCPDP

General Provider Information

NPI Number : 1467830638
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWAY SPECIALTY CARE RX LLC
Provider Business Mailing Address
First Line : 356 E MIDWAY ROAD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7148
Country : US
Telephone Number : 772-464-9746
Fax Number :
Provider Business Practice Location Address
First Line : 3255 S US HIGHWAY I
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-6381
Country : US
Telephone Number : 772-464-9746
Fax Number : 772-464-9750
Authorized Official
Title or Position : PHARMACY DIRECTOR
Name : SUZETTE WOOD
Credential : PHARMD
Telephone Number : 772-465-4442
Provider Enumeration Date : 05/08/2015
Last Update Date : 05/03/2022

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Directions to “MIDWAY SPECIALTY CARE RX LLC ” Practice Location

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