Provider Demographics
NPI:1437324209
Name:MIDLAND MEMORIAL OUTPAT PHARMACY
Entity Type:Organization
Organization Name:MIDLAND MEMORIAL OUTPAT PHARMACY
Other - Org Name:MMH OP RX
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-685-1584
Mailing Address - Street 1:200 ANDREWS HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6332
Mailing Address - Country:US
Mailing Address - Phone:432-571-4070
Mailing Address - Fax:432-571-4071
Practice Address - Street 1:200 ANDREWS HWY STE 102
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6332
Practice Address - Country:US
Practice Address - Phone:432-571-4070
Practice Address - Fax:432-571-4071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDLAND COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22804333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4534776OtherNCPDP