MEDICARE: MIDLAND PHARMACY , LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1427450956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLAND PHARMACY , LLC

Provider Business Mailing Address
First Line	:	3510 N. MIDKIFF RD, STE 100
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-697-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 N. MIDKIFF RD, STE 100
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-4834
Country	:	US
Telephone Number	:	432-697-7500
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SRINIVASA TALLA
Credential	:
Telephone Number	:	845-392-8254

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	08/24/2021

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Directions to “MIDLAND PHARMACY , LLC ” Practice Location

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