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General NPI Number Information
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NPI Number | 1215318209
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Entity Type | Organization
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Legal Business Name | CAROLINA MOUNTAIN PHARMACY INC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 11/15/2020
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Provider Practice Location Address
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Address Line | 7 PISGAH HWY STE 100
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City | CANDLER
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State | NC
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Zip | 28715-8991
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Country | US
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Telephone | 828-633-6700
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Fax | 828-633-6701
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Provider Business Mailing Address
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Address Line | 7 PISGAH HWY STE 100
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City | CANDLER
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State | NC
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Zip | 28715-8991
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Country | US
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Telephone | 828-633-6700
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Fax | 828-633-6701
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JARED MATTSON
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Credential |
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Telephone | 907-687-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12627
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License Number State | NC
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