Healthcare Provider Details

I. General information

NPI: 1083795421
Provider Name (Legal Business Name): BLUE MOUNTAIN PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 WRIGHT AVE
RICHLAND WA
99354-3011
US

IV. Provider business mailing address

1011 WRIGHT AVE
RICHLAND WA
99354-3011
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-1164
  • Fax: 509-946-6477
Mailing address:
  • Phone: 509-943-1164
  • Fax: 509-946-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60212940
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN REYNOLDS
Title or Position: OWNER
Credential:
Phone: 509-339-5295