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General NPI Number Information
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NPI Number | 1366889800
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Entity Type | Organization
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Legal Business Name | MIDWEST RX LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 212 MILLWELL DR STE B
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2512
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Country | US
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Telephone | 855-561-3600
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Fax | 866-830-0675
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Provider Business Mailing Address
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Address Line | 212 MILLWELL DR STE B
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2512
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Country | US
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Telephone | 855-561-3600
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Fax | 866-830-0675
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. JOHN DAVID HAMILTON
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Credential | RPH
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Telephone | 314-605-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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