Healthcare Provider Details

I. General information

NPI: 1881301323
Provider Name (Legal Business Name): BLUE MOUNTAIN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 MAIN ST
POMEROY WA
99347-9718
US

IV. Provider business mailing address

176 E MAIN ST
DAYTON WA
99328-1393
US

V. Phone/Fax

Practice location:
  • Phone: 509-843-1821
  • Fax: 509-843-3447
Mailing address:
  • Phone: 509-382-2536
  • Fax: 509-382-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN DYCE THURSTON
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 509-382-2536