Healthcare Provider Details

I. General information

NPI: 1457891830
Provider Name (Legal Business Name): MIDWESTERN COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N CHILLICOTHE ST
PLAIN CITY OH
43064-1045
US

IV. Provider business mailing address

PO BOX 126
PLAIN CITY OH
43064-0126
US

V. Phone/Fax

Practice location:
  • Phone: 614-733-3784
  • Fax: 614-721-7996
Mailing address:
  • Phone: 614-573-1557
  • Fax: 614-300-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-114560002136
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LONNIE JOE CRAFT
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 614-573-1557