Shade Mountain Pharmacy

LBN: Shade Mountain Pharmacy Llc
Shade Mountain Pharmacy is an health care organization with primary practice located at 9627 Route 35 Ste 20 , Mt Pleasant Mills PA 17853-8409. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Shade Mountain Pharmacy Llc can be contacted via phone (570) 539-2050, or through Trutt, Tyler via phone (570) 539-2050.

Contact Information

Primary practice address
9627 Route 35 Ste 20 Mt Pleasant Mills PA 17853-8409
Phone: (570) 539-2050
Fax: (570) 539-8581
Website:
Map and Directions
Authorized official contact:
Name: Trutt, Tyler
Phone: (570) 539-2050

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X PP413814L Pennsylvania

Profile Details

NPI number 1912067778
LBN Legal business name Shade Mountain Pharmacy Llc
DBA Doing business as Shade Mountain Pharmacy
Authorized official Trutt, Tyler
Entity Organization
Organization subpart 1 No
Enumeration date Dec 11th, 2006
Last updated May 1st, 2018 - about 8 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 1912067778 NPPES
Pennsylvania Other 3951399 NABP #
Pennsylvania MEDICAID 001047164001 NABP #

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