Healthcare Provider Details

I. General information

NPI: 1689319709
Provider Name (Legal Business Name): MIDWAY SPECIALTY CARE RX LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 E FOWLER AVE
TEMPLE TERRACE FL
33617-2147
US

IV. Provider business mailing address

3255 S US HIGHWAY 1
FORT PIERCE FL
34982-6381
US

V. Phone/Fax

Practice location:
  • Phone: 813-733-0602
  • Fax:
Mailing address:
  • Phone: 772-464-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUZETTE WOOD
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 772-464-9746