Provider Demographics
NPI:1336780246
Name:MIDLAND CARE PHARMACY LLC
Entity type:Organization
Organization Name:MIDLAND CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENUKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-279-0912
Mailing Address - Street 1:1111 N MIDKIFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-2158
Mailing Address - Country:US
Mailing Address - Phone:432-279-0912
Mailing Address - Fax:432-231-0911
Practice Address - Street 1:1111 N MIDKIFF RD STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-2120
Practice Address - Country:US
Practice Address - Phone:432-279-0912
Practice Address - Fax:432-231-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy