Mountain Lake Pharmacy
LBN: Mountain Lake Pharmacy Inc
Mountain Lake Pharmacy 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:
Health care specialties
| Specialty | Code | License # | 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 | Mountain Lake Pharmacy |
| Authorized official | Boone, Howard RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 3rd, 2006 |
| Last updated | Sep 10th, 2010 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336228006 | NPPES |
| West Virginia | MEDICAID | 6001398000 | |
| West Virginia | Other | 5054046 |
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