Provider Demographics
NPI:1366889800
Name:MIDWEST RX LLC
Entity type:Organization
Organization Name:MIDWEST RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-605-7340
Mailing Address - Street 1:212 MILLWELL DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2512
Mailing Address - Country:US
Mailing Address - Phone:855-561-3600
Mailing Address - Fax:866-830-0675
Practice Address - Street 1:212 MILLWELL DR STE B
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2512
Practice Address - Country:US
Practice Address - Phone:855-561-3600
Practice Address - Fax:866-830-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy