Healthcare Provider Details

I. General information

NPI: 1407885668
Provider Name (Legal Business Name): HIGH MOUNTAIN CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HANOVER ST
LEBANON NH
03766-1328
US

IV. Provider business mailing address

20 HANOVER ST
LEBANON NH
03766-1328
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-1778
  • Fax:
Mailing address:
  • Phone: 603-448-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0176
License Number StateNH

VIII. Authorized Official

Name: STEVEN HOCHBERG
Title or Position: VICE PRESIDENT
Credential:
Phone: 802-775-2545