<Unavail>

LBN: Mountain Lake Pharmacy Inc
<Unavail> is an health care organization with primary practice located at 1129 Broad St Ste 100, Summersville WV 26651-1838. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Mountain Lake Pharmacy Inc can be contacted via phone (304) 872-9000, or through Boone, Howard via phone (304) 872-9000.

Contact Information

Primary practice address
1129 Broad St Ste 100 Summersville WV 26651-1838
Phone: (304) 872-9000
Fax: (304) 872-4419
Website:
Map and Directions
Authorized official contact:
Name: Boone, Howard RPH
Phone: (304) 872-9000

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X SP0552314 West Virginia

Profile Details

NPI number 1336228006
LBN Legal business name Mountain Lake Pharmacy Inc
DBA Doing business as <Unavail>
Authorized official Boone, Howard RPH
Entity Organization
Organization subpart 1 No
Enumeration date Nov 3rd, 2006
Last updated Sep 10th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336228006 NPPES
West Virginia MEDICAID 6001398000
West Virginia Other 5054046

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