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General NPI Number Information
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NPI Number | 1689319709
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Entity Type | Organization
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Legal Business Name | MIDWAY SPECIALTY CARE RX LLC.
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 5224 E FOWLER AVE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2147
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Country | US
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Telephone | 813-733-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 S US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34982-6381
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Country | US
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Telephone | 772-464-9746
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | SUZETTE WOOD
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Credential | PHARMD
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Telephone | 772-464-9746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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