Provider Demographics
NPI:1639649916
Name:MIDLAND PHARMACY, LLC
Entity Type:Organization
Organization Name:MIDLAND PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURUM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-985-7011
Mailing Address - Street 1:4815 S 3500 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9439
Mailing Address - Country:US
Mailing Address - Phone:801-866-3047
Mailing Address - Fax:
Practice Address - Street 1:4815 S 3500 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9439
Practice Address - Country:US
Practice Address - Phone:801-985-7011
Practice Address - Fax:801-985-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy