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General NPI Number Information
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NPI Number | 1477595015
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Entity Type | Organization
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Legal Business Name | MIDWAY PHARMACY
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | BO RAYO CARR 117 INT 121 KM 4 2
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City | SABANA GRANDE
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State | PR
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Zip | 00637
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Country | US
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Telephone | 787-873-1480
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Fax | 787-804-1480
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Provider Business Mailing Address
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Address Line | BO MAGINA 22S C/MARGINA/STE 2
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City | SABANA GRANDE
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State | PR
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Zip | 00637
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN PHARMACIST
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Name | LILLAIN DOMINGUEZ
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Credential | RPH
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Telephone | 787-873-1480
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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 | 07F2067
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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