Provider Demographics
NPI:1841954005
Name:MIDWAY FAMILY PHARMACY PC
Entity type:Organization
Organization Name:MIDWAY FAMILY PHARMACY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SWENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-209-7457
Mailing Address - Street 1:1341 W MARINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4369
Mailing Address - Country:US
Mailing Address - Phone:801-209-7457
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6828
Practice Address - Country:US
Practice Address - Phone:435-315-3936
Practice Address - Fax:435-777-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy